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Dillenbeck E, Hollenberg J, Holzer M, Busch HJ, Nichol G, Radsel P, Belohlavec J, Torres EC, López-de-Sa E, Rosell F, Ristagno G, Forsberg S, Annoni F, Svensson L, Jonsson M, Bäckström D, Gellerfors M, Awad A, Taccone FS, Nordberg P. The design of the PRINCESS 2 trial: A randomized trial to study the impact of ultrafast hypothermia on complete neurologic recovery after out-of-hospital cardiac arrest with initial shockable rhythm. Am Heart J 2024; 271:97-108. [PMID: 38417773 DOI: 10.1016/j.ahj.2024.02.020] [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: 11/22/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Delayed hypothermia, initiated after hospital arrival, several hours after cardiac arrest with 8-10 hours to reach the target temperature, is likely to have limited impact on overall survival. However, the effect of ultrafast hypothermia, i.e., delivered intra-arrest or immediately after return of spontaneous circulation (ROSC), on functional neurologic outcome after out-of-hospital cardiac arrest (OHCA) is unclear. In two prior trials, prehospital trans-nasal evaporative intra-arrest cooling was safe, feasible and reduced time to target temperature compared to delayed cooling. Both studies showed trends towards improved neurologic recovery in patients with shockable rhythms. The aim of the PRINCESS2-study is to assess whether cooling, initiated either intra-arrest or immediately after ROSC, followed by in-hospital hypothermia, significantly increases survival with complete neurologic recovery as compared to standard normothermia care, in OHCA patients with shockable rhythms. METHODS/DESIGN In this investigator-initiated, randomized, controlled trial, the emergency medical services (EMS) will randomize patients at the scene of cardiac arrest to either trans-nasal cooling within 20 minutes from EMS arrival with subsequent hypothermia at 33°C for 24 hours after hospital admission (intervention), or to standard of care with no prehospital or in-hospital cooling (control). Fever (>37,7°C) will be avoided for the first 72 hours in both groups. All patients will receive post resuscitation care and withdrawal of life support procedures according to current guidelines. Primary outcome is survival with complete neurologic recovery at 90 days, defined as modified Rankin scale (mRS) 0-1. Key secondary outcomes include survival to hospital discharge, survival at 90 days and mRS 0-3 at 90 days. In total, 1022 patients are required to detect an absolute difference of 9% (from 45 to 54%) in survival with neurologic recovery (80% power and one-sided α=0,025, β=0,2) and assuming 2,5% lost to follow-up. Recruitment starts in Q1 2024 and we expect maximum enrolment to be achieved during Q4 2024 at 20-25 European and US sites. DISCUSSION This trial will assess the impact of ultrafast hypothermia applied on the scene of cardiac arrest, as compared to normothermia, on 90-day survival with complete neurologic recovery in OHCA patients with initial shockable rhythm. TRIAL REGISTRATION NCT06025123.
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Affiliation(s)
- Emelie Dillenbeck
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Peter Radsel
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Jan Belohlavec
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Liberec, Czech Republic
| | | | | | - Fernando Rosell
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), La Rioja, Spain
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Sune Forsberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Annoni
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Leif Svensson
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Denise Bäckström
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mikael Gellerfors
- Rapid Response Car, Capio, Stockholm, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Section for Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Akil Awad
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Fabio S Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Per Nordberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Mueller M, Losert H, Sterz F, Gelbenegger G, Girsa M, Gatterbauer M, Zajicek A, Grassmann D, Krammel M, Holzer M, Uray T, Schnaubelt S. Prehospital emergency medicine research by additional teams on scene - Concepts and lessons learned. Resusc Plus 2023; 16:100494. [PMID: 38026141 PMCID: PMC10658399 DOI: 10.1016/j.resplu.2023.100494] [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] [Indexed: 12/01/2023] Open
Abstract
While the initial minutes of acute emergencies significantly influence clinical outcomes, prehospital research often receives inadequate attention due to several challenges. Retrospective chart reviews carry the risk of incomplete and inaccurate data. Furthermore, prehospital intervention trials frequently encounter difficulties related to extensive training requirements, even during the planning phase. Consequently, we have implemented prospective research concepts involving additional paramedics and physicians directly at the scene during major emergency calls. Three concepts were used: (I) Paramedic field supervisor units, (II) a paramedic + physician field supervisor unit, (III) a special physician-based research car. This paper provides insights into our historical perspective, the current situation, and the lessons learned while overcoming certain barriers and using existing and novel facilitators. Our objective is to support other research groups with our experiences in their planning of upcoming prehospital trials.
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Affiliation(s)
- Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | | | | | - Daniel Grassmann
- Emergency Medical Service Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Mario Krammel
- Emergency Medical Service Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Thomas Uray
- Department of Cardiology, Clinic Floridsdorf, Vienna Healthcare Group, Austria
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
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Stadler JT, Habisch H, Prüller F, Mangge H, Bärnthaler T, Kargl J, Pammer A, Holzer M, Meissl S, Rani A, Madl T, Marsche G. HDL-Related Parameters and COVID-19 Mortality: The Importance of HDL Function. Antioxidants (Basel) 2023; 12:2009. [PMID: 38001862 PMCID: PMC10669705 DOI: 10.3390/antiox12112009] [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: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19, caused by the SARS-CoV-2 coronavirus, emerged as a global pandemic in late 2019, resulting in significant global public health challenges. The emerging evidence suggests that diminished high-density lipoprotein (HDL) cholesterol levels are associated with the severity of COVID-19, beyond inflammation and oxidative stress. Here, we used nuclear magnetic resonance spectroscopy to compare the lipoprotein and metabolic profiles of COVID-19-infected patients with non-COVID-19 pneumonia. We compared the control group and the COVID-19 group using inflammatory markers to ensure that the differences in lipoprotein levels were due to COVID-19 infection. Our analyses revealed supramolecular phospholipid composite (SPC), phenylalanine, and HDL-related parameters as key discriminators between COVID-19-positive and non-COVID-19 pneumonia patients. More specifically, the levels of HDL parameters, including apolipoprotein A-I (ApoA-I), ApoA-II, HDL cholesterol, and HDL phospholipids, were significantly different. These findings underscore the potential impact of HDL-related factors in patients with COVID-19. Significantly, among the HDL-related metrics, the cholesterol efflux capacity (CEC) displayed the strongest negative association with COVID-19 mortality. CEC is a measure of how well HDL removes cholesterol from cells, which may affect the way SARS-CoV-2 enters cells. In summary, this study validates previously established markers of COVID-19 infection and further highlights the potential significance of HDL functionality in the context of COVID-19 mortality.
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Affiliation(s)
- Julia T. Stadler
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
| | - Hansjörg Habisch
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (H.H.); (T.M.)
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
| | - Thomas Bärnthaler
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
| | - Julia Kargl
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
- BioTechMed Graz, 8010 Graz, Austria
| | - Anja Pammer
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
| | - Michael Holzer
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
| | - Sabine Meissl
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
| | - Alankrita Rani
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
| | - Tobias Madl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (H.H.); (T.M.)
- BioTechMed Graz, 8010 Graz, Austria
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (J.T.S.); (T.B.); (J.K.); (A.P.); (M.H.); (S.M.); (A.R.)
- BioTechMed Graz, 8010 Graz, Austria
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Stommel AM, Högler S, Mueller M, Magnet IAM, Kodajova P, Ullram B, Szinovatz A, Panzer FP, Engenhart-Seyrl A, Kaschmekat J, Schütz T, Holzer M, Weihs W. A ventricular fibrillation cardiac arrest model with extracorporeal cardiopulmonary resuscitation in rats: 8 minutes arrest time leads to increased myocardial damage but does not increase neuronal damage compared to 6 minutes. Front Vet Sci 2023; 10:1276588. [PMID: 38026669 PMCID: PMC10655001 DOI: 10.3389/fvets.2023.1276588] [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: 08/12/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging strategy in highly selected patients with refractory cardiac arrest (CA). Animal models can help to identify new therapeutic strategies to improve neurological outcome and cardiac function after global ischemia in CA. Aim of the study was to establish a reproducible ECPR rat model of ventricular fibrillation CA (VFCA) that leads to consistent neuronal damage with acceptable long-term survival rates, which can be used for future research. Materials and methods Male Sprague Dawley rats were resuscitated with ECPR from 6 min (n = 15) and 8 min (n = 16) VFCA. Animals surviving for 14 days after return of spontaneous resuscitation (ROSC) were compared with sham operated animals (n = 10); neurological outcome was assessed daily until day 14. In the hippocampal cornu ammonis 1 region viable neurons were counted. Microglia and astrocyte reaction was assessed by Iba1 and GFAP immunohistochemistry, and collagen fibers in the myocardium were detected in Azan staining. QuPath was applied for quantification. Results Of the 15 rats included in the 6 min CA group, all achieved ROSC (100%) and 10 (67%) survived to 14 days; in the 8 min CA group, 15 (94%) achieved ROSC and 5 (31%) reached the endpoint. All sham animals (n = 10) survived 2 weeks. The quantity of viable neurons was significantly decreased, while the area displaying Iba1 and GFAP positive pixels was significantly increased in the hippocampus across both groups that experienced CA. Interestingly, there was no difference between the two CA groups regarding these changes. The myocardium in the 8 min CA group exhibited significantly more collagen fibers compared to the sham animals, without differences between 6- and 8-min CA groups. However, this significant increase was not observed in the 6 min CA group. Conclusion Our findings indicate a uniform occurrence of neuronal damage in the hippocampus across both CA groups. However, there was a decrease in survival following an 8-min CA. Consequently, a 6-min duration of CA resulted in predictable neurological damage without significant cardiac damage and ensured adequate survival rates up to 14 days. This appears to offer a reliable model for investigating neuroprotective therapies.
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Affiliation(s)
| | - Sandra Högler
- Department of Pathobiology, Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Petra Kodajova
- Department of Pathobiology, Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Benjamin Ullram
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Szinovatz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Felix Paul Panzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Julia Kaschmekat
- Department of Pathobiology, Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Tamara Schütz
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weihs
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Zhakparov D, Quirin Y, Xiao Y, Battaglia N, Holzer M, Bühler M, Kistler W, Engel D, Zumthor JP, Caduff A, Baerenfaller K. Sequencing of SARS-CoV-2 RNA Fragments in Wastewater Detects the Spread of New Variants during Major Events. Microorganisms 2023; 11:2660. [PMID: 38004672 PMCID: PMC10672834 DOI: 10.3390/microorganisms11112660] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
The sequencing of SARS-CoV-2 RNA in wastewater is an unbiased method to detect the spread of emerging variants and to track regional infection dynamics, which is especially useful in case of limited testing and clinical sequencing. To test how major international events influence the spread of new variants we have sequenced SARS-CoV-2 RNA in the wastewater samples of Davos, Landquart, Lostallo, and St. Moritz in the Swiss canton of Grisons in the time around the international sports competitions in Davos and St. Moritz in December 2021, and additionally in May 2022 and January 2023 in Davos and St. Moritz during the World Economic Forum (WEF) in Davos. The prevalence of the variants identified from the wastewater sequencing data showed that the Omicron variant BA.1 had spread in Davos and St. Moritz during the international sporting events hosted there in December 2021. This spread was associated with an increase in case numbers, while it was not observed in Landquart and Lostallo. Another instance of new variant spread occurred during the WEF in January 2023, when the Omicron variant BA.2.75 arrived in Davos but not in St. Moritz. We can therefore conclude that major international events promote the spread of new variants in the respective host region, which has important implications for the protective measures that should be taken.
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Affiliation(s)
- Damir Zhakparov
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, 7265 Davos, Switzerland; (D.Z.)
- Swiss Institute of Bioinformatics (SIB), 1005 Lausanne, Switzerland
| | - Yves Quirin
- Cantonal Office for Nature and Environment, 7000 Chur, Switzerland
| | - Yi Xiao
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, 7265 Davos, Switzerland; (D.Z.)
- Swiss Institute of Bioinformatics (SIB), 1005 Lausanne, Switzerland
| | - Nicole Battaglia
- Cantonal Office for Food Security and Animal Health, 7000 Chur, Switzerland
| | - Michael Holzer
- Cantonal Office for Nature and Environment, 7000 Chur, Switzerland
| | - Martin Bühler
- Cantonal Office for Military and Civil Protection, 7000 Chur, Switzerland (A.C.)
| | | | | | - Jon Paulin Zumthor
- Cantonal Office for Food Security and Animal Health, 7000 Chur, Switzerland
| | - Alexa Caduff
- Cantonal Office for Military and Civil Protection, 7000 Chur, Switzerland (A.C.)
| | - Katja Baerenfaller
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, 7265 Davos, Switzerland; (D.Z.)
- Swiss Institute of Bioinformatics (SIB), 1005 Lausanne, Switzerland
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Hetzel C, Bühne D, Michel W, Holzer M, Froböse I. [More free time for me? Effects of a group intervention for informal caregivers based on routine data from the SVLFG long-term care insurance]. Z Gerontol Geriatr 2023; 56:477-483. [PMID: 35852589 DOI: 10.1007/s00391-022-02086-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The intervention is a multiday health program of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) for informal caregivers. AIM OF THE WORK Does the intervention increase the use of outside help to gain free time for self-care? MATERIAL AND METHODS Using a quasi-experimental within-design, we analyze annual benefit data from the SVLFG long-term care insurance for the cluster sample Bavaria from 2017 to 2020 with intervention in 2018/2019. Using fixed effects panel regressions, we determine the effect heterogeneity for care relationship, duration of care and degree of care, adjusting for period effects (intervention and comparison group: 88 and 6045 persons with 207 and 16,091 observations, respectively). RESULT After the intervention, the use of services for outside help tends to be higher than before. The effect is significantly more pronounced with increasing care level, care within the partnership and shorter care duration. With care within the partnership, start of care before 1 year and care level 4/5, more outside help is used afterwards for 1160 € (p < 0.001) than before. DISCUSSION Design and statistical method would allow a causal conclusion; however, in view of the limitations, in particular the small number of cases in the intervention group and the only limited characteristics available to control for time-dynamic heterogeneity, caution is advisable.
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Affiliation(s)
- Christian Hetzel
- Institut für Qualitätssicherung in Prävention und Rehabilitation iqpr GmbH, Deutsche Sporthochschule Köln, Eupener Str. 70, 50933, Köln, Deutschland.
| | - David Bühne
- Institut für Qualitätssicherung in Prävention und Rehabilitation iqpr GmbH, Deutsche Sporthochschule Köln, Eupener Str. 70, 50933, Köln, Deutschland
| | - Wolfgang Michel
- Sozialversicherung für Landwirtschaft, Forsten und Gartenbau, Weißensteinstraße 70-72, 34131, Kassel, Deutschland
| | - Michael Holzer
- Sozialversicherung für Landwirtschaft, Forsten und Gartenbau, Weißensteinstraße 70-72, 34131, Kassel, Deutschland
| | - Ingo Froböse
- Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland
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Holzer M, Poole JE, Lascarrou JB, Fujise K, Nichol G. A Commentary on the Effect of Targeted Temperature Management in Patients Resuscitated from Cardiac Arrest. Ther Hypothermia Temp Manag 2023; 13:102-111. [PMID: 36378270 PMCID: PMC10625468 DOI: 10.1089/ther.2022.0041] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The members of the International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force have written a comprehensive summary of trials of the effectiveness of induced hypothermia (IH) or targeted temperature management (TTM) in comatose patients after cardiac arrest (CA). However, in-depth analysis of these studies is incomplete, especially since there was no significant difference in primary outcome between hypothermia versus normothermia in the recently reported TTM2 trial. We critically appraise trials of IH/TTM versus normothermia to characterize reasons for the lack of treatment effect, based on a previously published framework for what to consider when the primary outcome fails. We found a strong biologic rationale and external clinical evidence that IH treatment is beneficial. Recent TTM trials mainly included unselected patients with a high rate of bystander cardiopulmonary resuscitation. The treatment was not applied as intended, which led to a large delay in achievement of target temperature. While receiving intensive care, sedative drugs were likely used that might have led to increased neurologic damage as were antiplatelet drugs that could be associated with increased acute stent thrombosis in hypothermic patients. It is reasonable to still use or evaluate IH treatment in patients who are comatose after CA as there are multiple plausible reasons why IH compared to normothermia did not significantly improve neurologic outcome in the TTM trials.
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Affiliation(s)
- Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jeanne E. Poole
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Ken Fujise
- Harborview Medical Center, Heart Institute, University of Washington, Seattle, Washington, USA
| | - Graham Nichol
- Departments of Medicine and Emergency Medicine, University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, Washington, USA
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Abstract
BACKGROUND Good neurological outcome after cardiac arrest is difficult to achieve. Interventions during the resuscitation phase and treatment within the first hours after the event are critical for a favourable prognosis. Experimental evidence suggests that therapeutic hypothermia is beneficial, and several clinical studies on this topic have been published. This review was originally published in 2009; updated versions were published in 2012 and 2016. OBJECTIVES To evaluate the benefits and harms of therapeutic hypothermia after cardiac arrest in adults compared to standard treatment. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 30 September 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in adults comparing therapeutic hypothermia after cardiac arrest with standard treatment (control). We included studies with adults cooled by any method, applied within six hours of cardiac arrest, to target body temperatures of 32 °C to 34 °C. Good neurological outcome was defined as no or only minor brain damage allowing people to live an independent life. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was 1. neurological recovery. Our secondary outcomes were 2. survival to hospital discharge, 3. quality of life, 4. cost-effectiveness and 5. ADVERSE EVENTS We used GRADE to assess certainty. MAIN RESULTS We found 12 studies with 3956 participants reporting the effects of therapeutic hypothermia on neurological outcome or survival. There were some concerns about the quality of all the studies, and two studies had high risk of bias overall. When we compared conventional cooling methods versus any type of standard treatment (including a body temperature of 36 °C), we found that participants in the therapeutic hypothermia group were more likely to reach a favourable neurological outcome (risk ratio (RR) 1.41, 95% confidence interval (CI) 1.12 to 1.76; 11 studies, 3914 participants). The certainty of the evidence was low. When we compared therapeutic hypothermia with fever prevention or no cooling, we found that participants in the therapeutic hypothermia group were more likely to reach a favourable neurological outcome (RR 1.60, 95% CI 1.15 to 2.23; 8 studies, 2870 participants). The certainty of the evidence was low. When we compared therapeutic hypothermia methods with temperature management at 36 °C, there was no evidence of a difference between groups (RR 1.78, 95% CI 0.70 to 4.53; 3 studies; 1044 participants). The certainty of the evidence was low. Across all studies, the incidence of pneumonia, hypokalaemia and severe arrhythmia was increased amongst participants receiving therapeutic hypothermia (pneumonia: RR 1.09, 95% CI 1.00 to 1.18; 4 trials, 3634 participants; hypokalaemia: RR 1.38, 95% CI 1.03 to 1.84; 2 trials, 975 participants; severe arrhythmia: RR 1.40, 95% CI 1.19 to 1.64; 3 trials, 2163 participants). The certainty of the evidence was low (pneumonia, severe arrhythmia) to very low (hypokalaemia). There were no differences in other reported adverse events between groups. AUTHORS' CONCLUSIONS Current evidence suggests that conventional cooling methods to induce therapeutic hypothermia may improve neurological outcomes after cardiac arrest. We obtained available evidence from studies in which the target temperature was 32 °C to 34 °C.
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Affiliation(s)
- Jasmin Arrich
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Nikola Schütz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Oppenauer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Janne Vendt
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christof Havel
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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9
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Gentile FR, Baldi E, Klersy C, Schnaubelt S, Caputo ML, Clodi C, Bruno J, Compagnoni S, Fasolino A, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. Association Between Postresuscitation 12-Lead ECG Features and Early Mortality After Out-of-Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study. J Am Heart Assoc 2023; 12:e027923. [PMID: 37183852 DOI: 10.1161/jaha.122.027923] [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] [Indexed: 05/16/2023]
Abstract
Background Once the return of spontaneous circulation after out-of-hospital cardiac arrest is achieved, a 12-lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30-day survival in patients with out-of-hospital cardiac arrest. Methods and Results All the post-return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53-70 years). After correction for the return of spontaneous circulation-to-ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21-2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05-2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43-1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39-1.59]; P<0.001), and the presence of ST-segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59-1.93]; P<0.001) were independently associated with 30-day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0-4, 73%; score 5-7, 66%; score 8-26, 45%). Conclusions The post-return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out-of-hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Francesca Romana Gentile
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | | | - Christian Clodi
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | | | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Alessandro Fasolino
- Department of Molecular Medicine, Section of Cardiology University of Pavia Pavia Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Hans Domanovits
- Clinical Epidemiology and Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | | | - Roberto Primi
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Gerhard Ruzicka
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | - Michael Holzer
- Department of Emergency Medicine Medical University of Vienna Wien Austria
| | | | - Simone Savastano
- Division of Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
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10
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Krammel M, Eichelter J, Gatterer C, Lobmeyr E, Neymayer M, Grassmann D, Holzer M, Sulzgruber P, Schnaubelt S. Differences in Automated External Defibrillator Types in Out-of-Hospital Cardiac Arrest Treated by Police First Responders. J Cardiovasc Dev Dis 2023; 10:jcdd10050196. [PMID: 37233163 DOI: 10.3390/jcdd10050196] [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: 03/23/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Police first responder systems also including automated external defibrillation (AED) has in the past shown considerable impact on favourable outcomes after out-of-hospital cardiac arrest (OHCA). While short hands-off times in chest compressions are known to be beneficial, various AED models use different algorithms, inducing longer or shorter durations of crucial timeframes along basic life support (BLS). Yet, data on details of these differences, and also of their potential impact on clinical outcomes are scarce. Methods: For this retrospective observational study, patients with OHCA of presumed cardiac origin and initially shockable rhythm treated by police first responders in Vienna, Austria, between 01/2013 and 12/2021 were included. Data from the Viennese Cardiac Arrest Registry and AED files were extracted, and exact timeframes were analyzed. Results: There were no significant differences in the 350 eligible cases in demographics, return of spontaneous circulation, 30-day survival, or favourable neurological outcome between the used AED types. However, the Philips HS1 and -FrX AEDs showed immediate rhythm analysis after electrode placement (0 [0-1] s) and almost no shock loading time (0 [0-1] s), as opposed to the LP CR Plus (3 [0-4] and 6 [6-6] s, respectively) and LP 1000 (3 [2-10] and 6 [5-7] s, respectively). On the other hand, the HS1 and -FrX had longer analysis times of 12 [12-16] and 12 [11-18] s than the LP CR Plus (5 [5-6] s) and LP 1000 (6 [5-8] s). The duration from when the AED was turned on until the first defibrillation were 45 [28-61] s (Philips FrX), 59 [28-81] s (LP 1000), 59 [50-97] s (HS1), and 69 [55-85] s (LP CR Plus). Conclusion: In a retrospective analysis of OHCA-cases treated by police first responders, we could not find significant differences in clinical patient outcomes concerning the respective used AED model. However, various differences in time durations (e.g., electrode placement to rhythm analysis, analysis duration, or AED turned on until first defibrillation) along the BLS algorithm were seen. This opens up the question of AED-adaptations and tailored training methods for professional first responders.
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Affiliation(s)
- Mario Krammel
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Emergency Medical Service (MA70), 1030 Vienna, Austria
| | - Jakob Eichelter
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Constantin Gatterer
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Lobmeyr
- Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Neymayer
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- PULS-Austrian Cardiac Arrest Awareness Association, 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
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11
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Voglhuber J, Matzer I, Djalinac N, Kiessling M, Trummer-Herbst V, Holzer M, Zirlik A, Holzer S. Spatio-specific CaMKII activation in cardiomyocytes from hypertensive Dahl salt-sensitive rats. Biophys J 2023; 122:236a. [PMID: 36783157 DOI: 10.1016/j.bpj.2022.11.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
- Julia Voglhuber
- Department of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed-Graz, Graz, Austria
| | - Ingrid Matzer
- Department of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed-Graz, Graz, Austria
| | - Natasa Djalinac
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Mara Kiessling
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Michael Holzer
- BioTechMed-Graz, Graz, Austria; Otto Loewi Research Centre, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Senka Holzer
- Department of Cardiology, Medical University of Graz, Graz, Austria; BioTechMed-Graz, Graz, Austria; Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
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12
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Stadler JT, van Poppel MNM, Wadsack C, Holzer M, Pammer A, Simmons D, Hill D, Desoye G, Marsche G. Obesity Affects Maternal and Neonatal HDL Metabolism and Function. Antioxidants (Basel) 2023; 12:antiox12010199. [PMID: 36671061 PMCID: PMC9854613 DOI: 10.3390/antiox12010199] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/15/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Pregravid obesity is one of the major risk factors for pregnancy complications such as gestational diabetes mellitus (GDM) and an increased risk of cardiovascular events in children of affected mothers. However, the biological mechanisms that underpin these adverse outcomes are not well understood. High-density lipoproteins (HDLs) are antiatherogenic by promoting the efflux of cholesterol from macrophages and by suppression of inflammation. Functional impairment of HDLs in obese and GDM-complicated pregnancies may have long-term effects on maternal and offspring health. In the present study, we assessed metrics of HDL function in sera of pregnant women with overweight/obesity of the DALI lifestyle trial (prepregnancy BMI ≥ 29 kg/m2) and women with normal weight (prepregnancy BMI < 25 kg/m2), as well as HDL functionalities in cord blood at delivery. We observed that pregravid obesity was associated with impaired serum antioxidative capacity and lecithin−cholesterol acyltransferase activity in both mothers and offspring, whereas maternal HDL cholesterol efflux capacity was increased. Interestingly, functionalities of maternal and fetal HDL correlated robustly. GDM did not significantly further alter the parameters of HDL function and metabolism in women with obesity, so obesity itself appears to have a major impact on HDL functionality in mothers and their offspring.
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Affiliation(s)
- Julia T. Stadler
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Mireille N. M. van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
- Correspondence: (M.N.M.v.P.); (G.M.); Tel.: +43-(0)-316-380-2335 (M.N.M.v.P.); +43-316-385-74128 (G.M.)
| | - Christian Wadsack
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
| | - Michael Holzer
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Anja Pammer
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW 2560, Australia
| | - David Hill
- Lawson Health Research Institute, London, ON N6C 2R5, Canada
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
- Correspondence: (M.N.M.v.P.); (G.M.); Tel.: +43-(0)-316-380-2335 (M.N.M.v.P.); +43-316-385-74128 (G.M.)
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13
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Voglhuber J, Holzer M, Radulović S, Thai PN, Djalinac N, Matzer I, Wallner M, Bugger H, Zirlik A, Leitinger G, Dedkova EN, Bers DM, Ljubojevic-Holzer S. Functional remodelling of perinuclear mitochondria alters nucleoplasmic Ca 2+ signalling in heart failure. Philos Trans R Soc Lond B Biol Sci 2022; 377:20210320. [PMID: 36189813 PMCID: PMC9527904 DOI: 10.1098/rstb.2021.0320] [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] [Indexed: 11/12/2022] Open
Abstract
Mitochondrial dysfunction in cardiomyocytes is a hallmark of heart failure development. Although initial studies recognized the importance of different mitochondrial subpopulations, there is a striking lack of direct comparison of intrafibrillar (IF) versus perinuclear (PN) mitochondria during the development of HF. Here, we use multiple approaches to examine the morphology and functional properties of IF versus PN mitochondria in pressure overload-induced cardiac remodelling in mice, and in non-failing and failing human cardiomyocytes. We demonstrate that PN mitochondria from failing cardiomyocytes are more susceptible to depolarization of mitochondrial membrane potential, reactive oxygen species generation and impairment in Ca2+ uptake compared with IF mitochondria at baseline and under physiological stress protocol. We also demonstrate, for the first time to our knowledge, that under normal conditions PN mitochondrial Ca2+ uptake shapes nucleoplasmic Ca2+ transients (CaTs) and limits nucleoplasmic Ca2+ loading. The loss of PN mitochondrial Ca2+ buffering capacity translates into increased nucleoplasmic CaTs and may explain disproportionate rise in nucleoplasmic [Ca2+] in failing cardiomyocytes at increased stimulation frequencies. Therefore, a previously unidentified benefit of restoring the mitochondrial Ca2+ uptake may be normalization of nuclear Ca2+ signalling and alleviation of altered excitation–transcription, which could be an important therapeutic approach to prevent adverse cardiac remodelling. This article is part of the theme issue ‘The cardiomyocyte: new revelations on the interplay between architecture and function in growth, health, and disease’.
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Affiliation(s)
- Julia Voglhuber
- Department of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - Michael Holzer
- BioTechMed-Graz, Graz, Austria.,Division of Pharmacology, Otto-Loewi Research Centre, Medical University of Graz, Graz, Austria
| | - Snježana Radulović
- Research Unit Electron Microscopic Techniques, Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Phung N Thai
- Department of Internal Medicine, Cardiovascular Medicine, University of California Davis, Davis, CA, USA
| | - Natasa Djalinac
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Ingrid Matzer
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Department of Cardiology, Medical University of Graz, Graz, Austria.,Lewis Katz School of Medicine, Temple University, Cardiovascular Research Center, Philadelphia, PA, USA
| | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Gerd Leitinger
- Research Unit Electron Microscopic Techniques, Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Elena N Dedkova
- Department of Pharmacology, University of California Davis, Davis, CA, USA.,Department of Molecular Biosciences, University of California Davis, Davis, CA, USA
| | - Donald M Bers
- Department of Pharmacology, University of California Davis, Davis, CA, USA
| | - Senka Ljubojevic-Holzer
- Department of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria.,Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
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14
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Ettl F, Schriefl C, Grafeneder J, Thallner DG, Mueller M, Fischer E, Schlegel R, Sigmund T, Holzer M, Schnaubelt S. A moodle course to substitute resuscitation teaching in a medical curriculum during the COVID-19 pandemic: A prospective pilot study. Front Public Health 2022; 10:991408. [PMID: 36438255 PMCID: PMC9691759 DOI: 10.3389/fpubh.2022.991408] [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: 08/03/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Face-to-face medical education was restricted during the COVID-19 pandemic, leading to alternative teaching methods. Moodle® (Modular Object-Oriented Dynamic Learning Environment) - an online course format - has not yet been sufficiently evaluated for its feasibility and effectiveness in teaching cardiopulmonary resuscitation. Methods Medical students in the eighth semester took part in a Moodle® course teaching basic life support, the ABCDE-approach, airway management, and advanced life support. The content was presented using digital background information and interactive videos. A multiple-choice test was conducted at the beginning and at the end of the course. Subjective ratings were included as well. Results Out of 594 students, who were enrolled in the online course, 531 could be included in this study. The median percentage of correctly answered multiple-choice test questions increased after completing the course [78.9%, interquartile range (IQR) 69.3-86.8 vs. 97.4%, IQR 92.1-100, p < 0.001]. There was no gender difference in the median percentage of correctly answered questions before (female: 79.8%, IQR 70.2-86.8, male: 78.1%, IQR 68.4-86.8, p = 0.412) or after (female: 97.4%, IQR 92.1-100, male: 96.5%, IQR 92.6-100, p = 0.233) the course. On a 5-point Likert scale, 78.7% of students self-reported ≥4 when asked for a subjective increase in knowledge. Noteworthy, on a 10-point Likert scale, male students self-reported their higher confidence in performing CPR [female 6 (5-7), male 7 (6-8), p < 0.001]. Conclusion The Moodle® course led to a significant increase in theoretical knowledge. It proved to be a feasible substitute for face-to-face courses - both objectively and subjectively.
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Affiliation(s)
- Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria,*Correspondence: Christoph Schriefl
| | - Jürgen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva Fischer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria,Department of Anaesthesiology, Clinic Donaustadt, Vienna Healthcare Group, Vienna, Austria
| | - Raphael Schlegel
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Thorsten Sigmund
- Department of IT-Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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15
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Holzer M, Ljubojevic-Holzer S, Souza Junior DR, Stadler JT, Rani A, Scharnagl H, Ronsein GE, Marsche G. HDL Isolated by Immunoaffinity, Ultracentrifugation, or Precipitation is Compositionally and Functionally Distinct. J Lipid Res 2022; 63:100307. [PMID: 36511335 PMCID: PMC9720336 DOI: 10.1016/j.jlr.2022.100307] [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: 07/27/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
The HDL proteome has been widely recognized as an important mediator of HDL function. While a variety of HDL isolation methods exist, their impact on the HDL proteome and its associated function remain largely unknown. Here, we compared three of the most common methods for HDL isolation, namely immunoaffinity (IA), density gradient ultracentrifugation (UC), and dextran-sulfate precipitation (DS), in terms of their effects on the HDL proteome and associated functionalities. We used state-of-the-art mass spectrometry to identify 171 proteins across all three isolation methods. IA-HDL contained higher levels of paraoxonase 1, apoB, clusterin, vitronectin, and fibronectin, while UC-HDL had higher levels of apoA2, apoC3, and α-1-antytrypsin. DS-HDL was enriched with apoA4 and complement proteins, while the apoA2 content was very low. Importantly, size-exclusion chromatography analysis showed that IA-HDL isolates contained subspecies in the size range above 12 nm, which were entirely absent in UC-HDL and DS-HDL isolates. Analysis of these subspecies indicated that they primarily consisted of apoA1, IGκC, apoC1, and clusterin. Functional analysis revealed that paraoxonase 1 activity was almost completely lost in IA-HDL, despite high paraoxonase content. We observed that the elution conditions, using 3M thiocyanate, during IA resulted in an almost complete loss of paraoxonase 1 activity. Notably, the cholesterol efflux capacity of UC-HDL and DS-HDL was significantly higher compared to IA-HDL. Together, our data clearly demonstrate that the isolation procedure has a substantial impact on the composition, subclass distribution, and functionality of HDL. In summary, our data show that the isolation procedure has a significant impact on the composition, subclass distribution and functionality of HDL. Our data can be helpful in the comparison, replication and analysis of proteomic datasets of HDL.
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Affiliation(s)
- Michael Holzer
- Division of Pharmacology, Otto-Loewi Research Centre, Medical University of Graz, Graz, Austria,BioTechMed Graz, Graz, Austria,For correspondence: Michael Holzer
| | - Senka Ljubojevic-Holzer
- BioTechMed Graz, Graz, Austria,Department of Cardiology, Medical University of Graz, Graz, Austria,Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | - Julia T. Stadler
- Division of Pharmacology, Otto-Loewi Research Centre, Medical University of Graz, Graz, Austria
| | - Alankrita Rani
- Division of Pharmacology, Otto-Loewi Research Centre, Medical University of Graz, Graz, Austria
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Graziella Eliza Ronsein
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | - Gunther Marsche
- Division of Pharmacology, Otto-Loewi Research Centre, Medical University of Graz, Graz, Austria,BioTechMed Graz, Graz, Austria
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16
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Mueller M, Jankow E, Grafeneder J, Schoergenhofer C, Poppe M, Schriefl C, Clodi C, Koch M, Ettl F, Holzer M, Losert H. The difference between arterial pCO 2 and etCO 2 after cardiac arrest - Outcome predictor or marker of unfavorable resuscitation circumstances? Am J Emerg Med 2022; 61:120-126. [PMID: 36096013 DOI: 10.1016/j.ajem.2022.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/13/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In former studies, the arterio-alveolar carbon dioxide gradient (ΔCO2) predicted in-hospital mortality after initially survived cardiac arrest. As early outcome predictors are urgently needed, we evaluated ΔCO2 as predictor for good neurological outcome in our cohort. METHODS We retrospectively analyzed all patients ≥18 years of age after non-traumatic in- and out of hospital cardiac arrest in the year 2018 from our resuscitation database. Patients without advanced airway management, incomplete datasets or without return of spontaneous circulation were excluded. The first arterial pCO2 after admission and the etCO2 in mmHg at the time of blood sampling were recorded from patient's charts. We then calculated ΔCO2 (pCO2 - etCO2). For baseline analyses, ΔCO2 was dichotomized into a low and high group with separation at the median. Good neurological outcome on day 30, expressed as Cerebral Performance Category 1-2, defined our primary endpoint. Survival to 30 days was used as secondary endpoint. RESULTS Out of 302 screened patients, 128 remained eligible for analyses. ΔCO2 was lower in 30-day survivors with good neurological outcome (12.2 mmHg vs. 18.8 mmHg, p = 0.009) and in 30-day survivors (12.5 mmHg vs. 20.0 mmHg, p = 0.001). In patients with high ΔCO2, a cardiac etiology of arrest was found less often. They had a higher body mass index, longer duration of resuscitation, higher amounts of epinephrine, lower pO2 levels but both higher pCO2 and blood lactate levels, resulting in lower blood pH and HCO3- levels at admission. In a crude binary logistic regression analysis, ΔCO2 was associated with 30-day neurological outcome (OR = 1.041 per mmHg of ΔCO2, 95% CI 1.008-1.074, p = 0.014). This association persisted after the adjustment for age, sex, witnessed arrest and shockable first rhythm. However, after addition of the duration of resuscitation or the cumulative epinephrine dosage to the model, ΔCO2 lost its association. CONCLUSION ΔCO2 at admission after a successfully resuscitated cardiac arrest is associated with 30 days survival with good neurological outcome. However, a higher ΔCO2 may rather be a surrogate for unfavorable resuscitation circumstances than an independent outcome predictor.
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Affiliation(s)
- Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Emmely Jankow
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| | | | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Moritz Koch
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Austria
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17
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Schnaubelt S, Eibensteiner F, Merrelaar M, Tihanyi D, Strassl R, Clodi C, Domanovits H, Losert H, Holzer M. Adult Respiratory Syncytial Virus Infection and Hypoxic Cardiac Arrest—Coexistent or Causal? A Hypothesis-Generating Case Report. Medicina (B Aires) 2022; 58:medicina58081121. [PMID: 36013588 PMCID: PMC9416440 DOI: 10.3390/medicina58081121] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a well-known pathogen in paediatric patients. However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. We present a patient with chronic pulmonary conditions and an acute RSV infection, thus leading to cardiac arrest (CA). We speculate that RSV as the causative agent for CA should be considered in post-resuscitation care. From a wider public health perspective, immuno-naivety for RSV caused by the coronavirus disease 2019 pandemic may induce a severe rise in cases, morbidity, and mortality in the future.
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Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Marieke Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniel Tihanyi
- Department of Pulmonology, Clinic Penzing, Vienna Healthcare Group, 1140 Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
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18
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Matzer I, Voglhuber J, Kiessling M, Djalinac N, Trummer-Herbst V, Mabotuwana N, Rech L, Holzer M, Sossalla S, Rainer PP, Zirlik A, Ljubojevic-Holzer S. β-Adrenergic Receptor Stimulation Maintains NCX-CaMKII Axis and Prevents Overactivation of IL6R-Signaling in Cardiomyocytes upon Increased Workload. Biomedicines 2022; 10:biomedicines10071648. [PMID: 35884952 PMCID: PMC9313457 DOI: 10.3390/biomedicines10071648] [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: 05/25/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Excessive β-adrenergic stimulation and tachycardia are potent triggers of cardiac remodeling; however, their exact cellular effects remain elusive. Here, we sought to determine the potency of β-adrenergic stimulation and tachycardia to modulate gene expression profiles of cardiomyocytes. Using neonatal rat ventricular cardiomyocytes, we showed that tachycardia caused a significant upregulation of sodium–calcium exchanger (NCX) and the activation of calcium/calmodulin-dependent kinase II (CaMKII) in the nuclear region. Acute isoprenaline treatment ameliorated NCX-upregulation and potentiated CaMKII activity, specifically on the sarcoplasmic reticulum and the nuclear envelope, while preincubation with the β-blocker propranolol abolished both isoprenaline-mediated effects. On a transcriptional level, screening for hypertrophy-related genes revealed tachycardia-induced upregulation of interleukin-6 receptor (IL6R). While isoprenaline prevented this effect, pharmacological intervention with propranolol or NCX inhibitor ORM-10962 demonstrated that simultaneous CaMKII activation on the subcellular Ca2+ stores and prevention of NCX upregulation are needed for keeping IL6R activation low. Finally, using hypertensive Dahl salt-sensitive rats, we showed that blunted β-adrenergic signaling is associated with NCX upregulation and enhanced IL6R signaling. We therefore propose a previously unrecognized protective role of β-adrenergic signaling, which is compromised in cardiac pathologies, in preventing IL6R overactivation under increased workload. A better understanding of these processes may contribute to refinement of therapeutic options for patients receiving β-blockers.
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Affiliation(s)
- Ingrid Matzer
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Julia Voglhuber
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- BioTechMed-Graz, 8010 Graz, Austria;
- Correspondence: (J.V.); (S.L.-H.)
| | - Mara Kiessling
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Nataša Djalinac
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Viktoria Trummer-Herbst
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Nishani Mabotuwana
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
| | - Lavinia Rech
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Michael Holzer
- BioTechMed-Graz, 8010 Graz, Austria;
- Otto-Loewi Research Centre, Division of Pharmacology, Medical University of Graz, 8036 Graz, Austria
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Centre Regensburg, 93053 Regensburg, Germany;
| | - Peter P. Rainer
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- BioTechMed-Graz, 8010 Graz, Austria;
| | - Andreas Zirlik
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
| | - Senka Ljubojevic-Holzer
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; (I.M.); (M.K.); (N.D.); (V.T.-H.); (N.M.); (L.R.); (P.P.R.); (A.Z.)
- BioTechMed-Graz, 8010 Graz, Austria;
- Gottfried Schatz Research Center, Division of Molecular Biology and Biochemistry, Medical University of Graz, 8010 Graz, Austria
- Correspondence: (J.V.); (S.L.-H.)
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19
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Matzer I, Voglhuber J, Djalinac N, Trummer-Herbst V, Kiessling M, Fernandes Hollnagel C, Rech L, Holzer M, Ljubojevic-Holzer S. Beta-1 adrenergic receptor signalling during early and late hypertensive cardiac remodelling. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): BioTechMed Graz
Objective
Chronic activation of β1-adrenergic receptors (β1AR) in response to hypertension is consistently linked to maladaptive remodelling in the heart, however, the underlying mechanisms are not well understood. Here, our aim was to determine the subcellular profile and extent of β1AR expression at baseline and upon acute β-adrenergic stimulation in cardiac myocytes during early- and late-stage cardiac remodelling due to systemic hypertension.
Methods
Male Dahl salt-sensitive rats were fed a high-salt diet (HSD; 8% NaCl) for either five or ten weeks to induce early or late hypertensive cardiac remodelling, respectively. Age-, sex- and weight-matched Dahl salt-sensitive rats on a low-salt diet (LSD; 0.3% NaCl) served as controls. To test the effect of conventional anti-hypertensive treatment, a subset of HSD-fed animals received daily doses of the angiotensin-converting-enzyme-inhibitor Imidapril (ACE-I; 1mg/kg/day) starting two weeks after the feeding protocol was switched to HSD. Isolated ventricular myocytes were stimulated either under control conditions or in the presence of β-adrenergic agonist isoprenaline (ISO; 100nM; 1h). Confocal imaging of single cardiomyocytes allowed detailed quantification of β1AR in different cellular compartments. Finally, immunoblotting and microarray analyses were applied to quantify β1AR in the left ventricles of the corresponding groups of animals.
Results
In control rats, β1AR was found in a striated pattern throughout the cell typical for T-tubular network and in the perinuclear regions, while its expression significantly dropped upon ISO treatment. During early remodelling, basal β1AR expression was unchanged, but increased on the T-tubules and perinuclear regions upon acute stimulation with ISO. In contrast, late remodelling was marked by reduced β1AR expression at baseline, and significantly blunted increase in response to ISO compared to early time point. Interestingly, daily ACE-I treatment resulted in even more adverse phenotype as compared to untreated HSD-fed rats in early remodelling, but favourable control-like characteristics at late remodelling stage. Immunoblotting and microarrays from left ventricular tissue confirmed the data, where applicable.
Conclusion
Taken together, we showed that early hypertensive remodelling is marked by altered β1AR responsiveness upon β-adrenergic stimulation, whereas late remodelling also exhibits altered β1AR expression. ACE-I treatment seemed to interfere with early adaptive mechanisms, thereby worsening the phenotype as compared to untreated HSD-fed animals. However, upon prolonged application, it showed a clear protective effect from pathological molecular alterations at late remodelling. Further experiments involving downstream targets of β1AR signalling are required to fully understand the molecular sequence of events leading to early and late alterations in molecular composition of cardiomyocytes in the hypertensive heart.
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Affiliation(s)
- I Matzer
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - J Voglhuber
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - N Djalinac
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - V Trummer-Herbst
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - M Kiessling
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | | | - L Rech
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - M Holzer
- Medical University of Graz, Division of Pharmacology, Otto-Loewi Research Center , Graz , Austria
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20
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Voglhuber J, Holzer M, Radulovic S, Thai PN, Djalinac N, Matzer I, Wallner M, Bugger H, Zirlik A, Leitinger G, Dedkova EN, Bers DM, Ljubojevic-Holzer S. Functional remodeling of perinuclear mitochondria alters nucleoplasmic Ca2+ signaling in heart failure. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): BioTechMed-Graz
Mitochondrial dysfunction in cardiomyocytes is a hallmark of heart failure (HF) development. Although initial studies recognized the importance of different mitochondrial subpopulations, there is a striking lack of direct comparison of intrafibrillar (IF) vs. perinuclear (PN) mitochondria during the development of HF.
Here, we use multiple approaches to examine the morphology and functional properties of IF vs. PN mitochondria in pressure overload-induced cardiac remodeling in mice, and in non-failing and failing human cardiomyocytes. We could demonstrate that PN mitochondria from failing cardiomyocytes are more susceptible to changes in mitochondrial membrane potential (ΔΨm), ROS generation and impairment in Ca2+ uptake compared to IF mitochondria at baseline and under physiological stress protocol. We also demonstrated, for the first time, that under normal conditions PN mitochondrial Ca2+ uptake shapes nucleoplasmic Ca2+ transients (CaTs) and prevents nucleoplasmic Ca2+ overload. Loss of PN mitochondria Ca2+ buffering capacity translates into increased nucleoplasmic CaTs and may explain disproportionate rise in nucleoplasmic [Ca2+] in failing cardiomyocytes at increased stimulation frequencies. Therefore, a previously unidentified benefit of restoring the mitochondrial Ca2+ uptake may be normalization of nuclear Ca2+ signaling and alleviation of altered excitation-transcription, which could be an important therapeutic approach to prevent adverse cardiac remodeling.
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Affiliation(s)
- J Voglhuber
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - M Holzer
- Medical University of Graz, Division of Pharmacology, Otto-Loewi Research Center , Graz , Austria
| | - S Radulovic
- Medical University of Graz, Research Unit Electron Microscopic Techniques, Gottfried Schatz Research Center , Graz , Austria
| | - PN Thai
- University of California, Department of Internal Medicine, Cardiovascular Medicine , Davis , United States of America
| | - N Djalinac
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - I Matzer
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - M Wallner
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - H Bugger
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - A Zirlik
- Medical University of Graz, Department of Cardiology , Graz , Austria
| | - G Leitinger
- Medical University of Graz, Research Unit Electron Microscopic Techniques, Gottfried Schatz Research Center , Graz , Austria
| | - EN Dedkova
- University of California, Department of Pharmacology , Davis , United States of America
| | - DM Bers
- University of California, Department of Pharmacology , Davis , United States of America
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21
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Schriefl C, Schoergenhofer C, Buchtele N, Mueller M, Poppe M, Clodi C, Ettl F, Merrelaar A, Boegl MS, Steininger P, Holzer M, Herkner H, Schwameis M. Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest. J Pers Med 2022; 12:jpm12060876. [PMID: 35743661 PMCID: PMC9225634 DOI: 10.3390/jpm12060876] [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: 04/14/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The clinical value of a prognostic score depends on its out-of-sample validity because inaccurate outcome prediction can be not only useless but potentially fatal. We aimed to evaluate the out-of-sample validity of a recently developed and highly accurate Korean prognostic score for predicting neurologic outcome after cardiac arrest in an independent, plausibly related sample of European cardiac arrest survivors. Methods: Analysis of data from a European cardiac arrest center, certified in compliance with the specifications of the German Council for Resuscitation. The study sample included adults with nontraumatic out-of-hospital cardiac arrest admitted between 2013 and 2018. Exposure was the PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages (PROLOGUE) score, including 12 clinical variables readily available at hospital admission. The outcome was poor 30-day neurologic function, as assessed using the cerebral performance category scale. The risk of a poor outcome was calculated using the PROLOGUE score regression equation. Predicted risk deciles were compared to observed outcome estimates in a complete-case analysis, a best-case analysis, and a multiple-data-imputation analysis using the Markov chain Monte Carlo method. Results: A total of 1051 patients (median 61 years, IQR 50–71; 29% female) were analyzed. A total of 808 patients (77%) were included in the complete-case analysis. The PROLOGUE score overestimated the risk of poor neurologic outcomes in the range of 40% to 100% predicted risk, involving 63% of patients. The model fit did not improve after missing data imputation. Conclusions: In a plausibly related sample of European cardiac arrest survivors, risk prediction by the PROLOGUE score was largely too pessimistic and failed to replicate the high accuracy found in the original study. Using the PROLOGUE score as an example, this study highlights the compelling need for independent validation of a proposed prognostic score to prevent potentially fatal mispredictions.
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Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | | | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Anne Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Magdalena Sophie Boegl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Philipp Steininger
- Emergency Department, Clinic Hietzing, Vienna Healthcare Group, 1130 Vienna, Austria;
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
- Correspondence:
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
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22
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Gentile F, Baldi E, Schnaubelt S, Caputo M, Clodi C, Bruno J, Compagnoni S, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. C60 12–LEAD POST–ROSC ELECTROCARDIOGRAM DISCRIMINATES SURVIVAL TO HOSPITAL DISCHARGE. A SUB–ANALYSIS OF THE PEACE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Once the return of spontaneous circulation (ROSC) after an out–of–hospital cardiac arrest (OHCA) is achieved in patients with an ST–elevation myocardial infarction, the acquisition of a 12–lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far about the association of ECG features and survival to hospital discharge in OHCA patients.
Methods
We analysed all the post–ROSC ECGs collected from January 2015 to December 2018 in three European centres (Pavia, Lugano and Vienna). For every ECG, the main features were analysed and filed in the database together with the pre–hospital data collected for every patient according to the Utstein style.
Results
We collected 370 ECGs: 287 males (77.6%); median age 62 years old (IQR 53–70 years); 121 from Pavia (32.7%), 38 from Lugano (10.3%) and 211 from Vienna (57.0%). In Cox univariable regression, age older than 62 years [HR 1.7 (95% IC 1.1–2.4), p = 0.007], QRS wider than 120 msec [HR 1.87 (95% IC 1.3–2.7), p < 0.001], ST elevation in more than one segment [HR 1.7(95% IC 1.2–2.5),p=0.003], the presence of left bundle branch block (LBBB) [HR 1.7 (95% IC 1.1–2.9), p = 0.03] and a right bundle branch block [HR 1.8 (95% IC 1.1–2.8), p = 0.01] were all associated with death before hospital discharge. In multivariable Cox regression, adjusted for the ROSC–to–ECG time, age older than 62 years [HR 1.6 (95% IC 1.1–2.3), p = 0.01], QRS wider than 120 msec [HR 1.7 (95%IC 1.2–2.5), p = 0.004] and the presence of ST elevation in more than one segment [HR 1.7 (95%IC 1.2–2.5), p = 0.004] were independently associated with death before hospital discharge. By considering these latter three risk factors, the rate of survival to hospital discharge was significantly influenced by their number [no risk factor: 80.8%; 1 factor: 71.2%; 2 factors: 61.9%; 3 factors: 34.4%; p < 0.001, p for trend <0.001]. With a Cox regression model, considering the absence of risk factor as a reference, we confirmed that having 2 or 3 risk factors was significantly associated with death before hospital discharge [HR 1.9 (95%IC 1–3.5), p = 0.037 e HR 5.1(95%IC 2.6–10.1), p < 0.001 respectively].
Conclusions
Our study confirms the central role of ECG in STEMI patients resuscitated after an OHCA and proves that post–ROSC ECG features can be used for both the selection of patients who may benefit from urgent coronary angiography as well as for prognostic stratifications.
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Affiliation(s)
- F Gentile
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - E Baldi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Schnaubelt
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - M Caputo
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - C Clodi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - J Bruno
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Compagnoni
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - C Benvenuti
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - H Domanovits
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - R Burkart
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - R Primi
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - G Ruzicka
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - M Holzer
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - A Auricchio
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
| | - S Savastano
- DIVISONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; DEPARTMENT OF EMERGENCY MEDICINE, MEDICAL UNIVERSITY OF VIENNA, AUSTRIA; CARDIOCENTRO TICINO, LUGANO, SWITZERLAND; DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; FONDAZIONE TICINO CUORE, BREGANZONA, LUGANO SWITZERLAND
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Schriefl C, Schwameis M, Ettl F, Poppe M, Clodi C, Mueller M, Grafeneder J, Eskandary F, Reindl-Schwaighofer R, Warenits AM, Kupis A, Holzer M, Sterz F, Schoergenhofer C. Blood urea nitrogen kinetics in the early postcardiac arrest phase are associated with clinical outcome: A retrospective cohort study. Eur J Anaesthesiol 2022; 39:405-407. [PMID: 34261100 PMCID: PMC8900999 DOI: 10.1097/eja.0000000000001572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Christoph Schriefl
- From the Department of Emergency Medicine (CSchr, MS, FE, MP, CC, MM, JG, AMW, MH, FS), Department of Medicine III (FE, RRS) and Department of Clinical Pharmacology (AK, CScho), Medical University of Vienna, Vienna, Austria
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24
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Voglhuber J, Holzer M, Radulovic S, Thai PN, Djalinac N, Matzer I, Wallner M, Bugger H, Zirlik A, Leitinger G, Dedkova EN, Bers DM, Ljubojevic S. Functional remodeling of perinuclear mitochondria alters nucleoplasmic Ca2+signaling in heart failure. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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Schnaubelt S, Mayr FB, Losert H, Domanovits H, Sulzgruber P, Holzer M, Sterz F, Uray T. Very long-term survivors of in-hospital and out-of-hospital cardiac arrest show considerable impairment of daily life. Resuscitation 2022; 173:192-200. [DOI: 10.1016/j.resuscitation.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 01/27/2023]
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26
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Poppe M, Clodi C, Schriefl C, Mueller M, Sunder-Plaßmann R, Reiter B, Rechenmacher M, van Os W, van Hasselt JGC, Holzer M, Herkner H, Schwameis M, Jilma B, Schoergenhofer C, Weiser C. Targeted temperature management after cardiac arrest is associated with reduced metabolism of pantoprazole - A probe drug of CYP2C19 metabolism. Biomed Pharmacother 2021; 146:112573. [PMID: 34959115 DOI: 10.1016/j.biopha.2021.112573] [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: 10/21/2021] [Revised: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE Targeted temperature management (TTM) is part of standard post-resuscitation care. TTM may downregulate cytochrome enzyme activity and thus impact drug metabolism. This study compared the pharmacokinetics (PK) of pantoprazole, a probe drug of CYP2C19-dependent metabolism, at different stages of TTM following cardiac arrest. METHODS This prospective controlled study was performed at the Medical University of Vienna and enrolled 16 patients following cardiac arrest. The patients completed up to three study periods (each lasting 24 h) in which plasma concentrations of pantoprazole were quantified: (P1) hypothermia (33 °C) after admission, (P2) normothermia after rewarming (36 °C, intensive care), and (P3) normothermia during recovery (normal ward, control group). PK was analysed using non-compartmental analysis and nonlinear mixed-effects modelling. RESULTS 16 patients completed periods P1 and P2; ten completed P3. The median half-life of pantoprazole was 2.4 h (quartiles: 1.8-4.8 h) in P1, 2.8 h (2.1-6.8 h, p = 0.046 vs. P1, p = 0.005 vs. P3) in P2 and 1.2 h (0.9 - 2.3 h, p = 0.007 vs. P1) in P3. A two-compartment model described the PK data best. Typical values for clearance were estimated separately for each study period, indicating 40% and 29% reductions during P1 and P2, respectively, compared to P3. The central volume of distribution was estimated separately for P2, indicating a 64% increase compared to P1 and P3. CONCLUSION CYP2C19-dependent drug metabolism is downregulated during TTM following cardiac arrest. These results may influence drug choice and dosing of similarly metabolized drugs and may be helpful for designing studies in similar clinical situations.
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Affiliation(s)
- Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Raute Sunder-Plaßmann
- Clinical Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Reiter
- Clinical Institute of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Wisse van Os
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, Austria
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27
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Schriefl C, Steininger P, Clodi C, Mueller M, Poppe M, Ettl F, Nuernberger A, Grafeneder J, Losert H, Schwameis M, Holzer M, Sterz F, Schoergenhofer C. The association of early diarrhea after successful resuscitation following out-of-hospital cardiac arrest with neurological outcome: A retrospective observational study. Medicine (Baltimore) 2021; 100:e28164. [PMID: 34889287 PMCID: PMC8663854 DOI: 10.1097/md.0000000000028164] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
Gastrointestinal ischemia with reperfusion tissue injury contributes to post-cardiac arrest syndrome. We hypothesized that diarrhea is a symptom of intestinal ischemia/reperfusion injury and investigated whether the occurrence of early diarrhea (≤12 hours) after successful cardiopulmonary resuscitation is associated with an unfavorable neurological outcome.We analyzed data from the Vienna Clinical Cardiac Arrest Registry. Inclusion criteria comprised ≥18 years of age, a witnessed, non-traumatic out-of-hospital cardiac arrest, return of spontaneous circulation (ROSC), initial shockable rhythm, and ST-segment elevation in electrocardiogram after ROSC with consecutive coronary angiography. Patients with diarrhea caused by other factors (e.g., infections, antibiotic treatment, or chronic diseases) were excluded. The primary endpoint was neurological function between patients with or without "early diarrhea" (≤12 hours after ROSC) according to cerebral performance categories.We included 156 patients between 2005 and 2012. The rate of unfavorable neurologic outcome was higher in patients with early diarrhea (67% vs 37%). In univariate analysis, the crude odds ratio for unfavorable neurologic outcome was 3.42 (95% confidence interval, 1.11-10.56, P = .03) for early diarrhea. After multivariate adjustment for traditional prognostication markers the odds ratio of early diarrhea was 5.90 (95% confidence interval, 1.28-27.06, P = .02).In conclusion, early diarrhea within 12 hours after successful cardiopulmonary resuscitation was associated with an unfavorable neurological outcome.
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Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Philipp Steininger
- Emergency Department, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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28
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Mueller M, Grafeneder J, Schoergenhofer C, Schwameis M, Schriefl C, Poppe M, Clodi C, Koch M, Sterz F, Holzer M, Ettl F. Initial Blood pH, Lactate and Base Deficit Add No Value to Peri-Arrest Factors in Prognostication of Neurological Outcome After Out-of-Hospital Cardiac Arrest. Front Med (Lausanne) 2021; 8:697906. [PMID: 34604252 PMCID: PMC8483260 DOI: 10.3389/fmed.2021.697906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background: In cardiac arrest survivors, metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction. However, the additional value of this strategy remains unclear. Methods: We used our resuscitation database to screen all patients ≥18 years who had suffered in- or out-of-hospital cardiac arrest (IHCA, OHCA) between January 1st, 2005 and May 1st, 2019. Patients with incomplete data, without return of spontaneous circulation or treatment with sodium bicarbonate were excluded. To analyse the added value of metabolic parameters to prognosticate neurological function, we built three models using logistic regression. These models included: (1) Peri-arrest factors only, (2) peri-arrest factors plus metabolic parameters and (3) metabolic parameters only. Receiver operating characteristics curves regarding 30-day good neurological function (Cerebral Performance Category 1-2) were analysed. Results: A total of 2,317 patients (OHCA: n = 1842) were included. In patients with OHCA, model 1 and 2 had comparable predictive value. Model 3 was inferior compared to model 1. In IHCA patients, model 2 performed best, whereas both metabolic (model 3) and peri-arrest factors (model 1) demonstrated similar power. PH, lactate and BD had interchangeable areas under the curve in both IHCA and OHCA. Conclusion: Although metabolic parameters may play a role in IHCA, no additional value in the prediction of good neurological outcome could be found in patients with OHCA. This highlights the importance of accurate anamnesis especially in patients with OHCA.
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Affiliation(s)
- Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Moritz Koch
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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29
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Schriefl C, Schoergenhofer C, Poppe M, Clodi C, Mueller M, Ettl F, Jilma B, Grafeneder J, Schwameis M, Losert H, Holzer M, Sterz F, Zeiner-Schatzl A. Author Correction: Admission C-reactive protein concentrations are associated with unfavourable neurological outcome after out-of-hospital cardiac arrest. Sci Rep 2021; 11:18912. [PMID: 34535712 PMCID: PMC8448892 DOI: 10.1038/s41598-021-98687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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30
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Früh A, Bileck A, Muqaku B, Wurm R, Neuditschko B, Arfsten H, Galli L, Kriechbaumer L, Hubner P, Goliasch G, Heinz G, Holzer M, Sterz F, Adlbrecht C, Gerner C, Distelmaier K. Catalase Predicts In-Hospital Mortality after Out-of-Hospital Cardiac Arrest. J Clin Med 2021; 10:jcm10173906. [PMID: 34501367 PMCID: PMC8432041 DOI: 10.3390/jcm10173906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022] Open
Abstract
The generation of harmful reactive oxygen species (ROS), including hydrogen peroxide, in out-of-hospital cardiac arrest (OHCA) survivors causes systemic ischemia/reperfusion injury that may lead to multiple organ dysfunction and mortality. We hypothesized that the antioxidant enzyme catalase may attenuate these pathophysiological processes after cardiac arrest. Therefore, we aimed to analyze the predictive value of catalase levels for mortality in OHCA survivors. In a prospective, single-center study, catalase levels were determined in OHCA survivors 48 h after the return of spontaneous circulation. Thirty-day mortality was defined as the study end point. A total of 96 OHCA survivors were enrolled, of whom 26% (n = 25) died within the first 30 days after OHCA. The median plasma intensity levels (log2) of catalase were 8.25 (IQR 7.64–8.81). Plasma levels of catalase were found to be associated with mortality, with an adjusted HR of 2.13 (95% CI 1.07–4.23, p = 0.032). A Kaplan–Meier analysis showed a significant increase in 30-day mortality in patients with high catalase plasma levels compared to patients with low catalase levels (p = 0.012). High plasma levels of catalase are a strong and independent predictor for 30-day mortality in OHCA survivors. This indicates that ROS-dependent tissue damage is playing a crucial role in fatal outcomes of post-cardiac syndrome patients.
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Affiliation(s)
- Anton Früh
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
| | - Besnik Muqaku
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
| | - Raphael Wurm
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Benjamin Neuditschko
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Department of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Lukas Galli
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Lukas Kriechbaumer
- University Clinic of Orthopedics, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Gottfried Heinz
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | | | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Klaus Distelmaier
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
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31
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Noc M, Laanmets P, Neskovic A, Petrović M, Stanetic B, Aradi D, Kiss R, Ungi I, Merkely B, Hudec M, Blasko P, Horvath I, Davies J, Vukcevic V, Holzer M, Metzler B, Witkowski AR, Erglis A, Fister M, Nagy G, Bulum J, Édes I, Peruga J, Średniawa B, Erlinge D, Keeble TR. A multicentre, prospective, randomised controlled trial to assess the safety and effectiveness of cooling as an adjunctive therapy to percutaneous intervention in patients with acute myocardial infarction: the COOL AMI EU Pivotal Trial. EUROINTERVENTION 2021; 17:466-473. [PMID: 34031023 PMCID: PMC9725068 DOI: 10.4244/eij-d-21-00348] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite primary PCI (PPCI), ST-elevation myocardial infarction (STEMI) can still result in large infarct size (IS). New technology with rapid intravascular cooling showed positive signals for reduction in IS in anterior STEMI. AIMS We investigated the effectiveness and safety of rapid systemic intravascular hypothermia as an adjunct to PPCI in conscious patients, with anterior STEMI, without cardiac arrest. METHODS Hypothermia was induced using the ZOLL® Proteus™ intravascular cooling system. After randomisation of 111 patients, 58 to hypothermia and 53 to control groups, the study was prematurely discontinued by the sponsor due to inconsistent patient logistics between the groups resulting in significantly longer total ischaemic delay in the hypothermia group (232 vs 188 minutes; p<0.001). RESULTS There were no differences in angiographic features and PPCI result between the groups. Intravascular temperature at wire crossing was 33.3+0.9°C. Infarct size/left ventricular (IS/LV) mass by cardiac magnetic resonance (CMR) at day 4-6 was 21.3% in the hypothermia group and 20.0% in the control group (p=0.540). Major adverse cardiac events at 30 days increased non-significantly in the hypothermia group (8.6% vs 1.9%; p=0.117) while cardiogenic shock (10.3% vs 0%; p=0.028) and paroxysmal atrial fibrillation (43.1% vs 3.8%; p<0.001) were significantly more frequent in the hypothermia group. CONCLUSIONS The ZOLL Proteus intravascular cooling system reduced temperature to 33.3°C before PPCI in patients with anterior STEMI. Due to inconsistent patient logistics between the groups, this hypothermia protocol resulted in a longer ischaemic delay, did not reduce IS/LV mass and was associated with increased adverse events.
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Affiliation(s)
- Marko Noc
- Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia
| | - Peep Laanmets
- North-Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Aleksandar Neskovic
- Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milovan Petrović
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, Novi Sad, Serbia
| | - Bojan Stanetic
- University Clinical Center of the Republic of Srpska, Medical Faculty of University of Banja Luka, Banja Luka, Bosnia
| | | | | | - Imre Ungi
- University of Szeged, Szeged, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Martin Hudec
- Stredoslovenski Ustav Srdcovych a Cievnych Chorob, Banska Bystrica, Slovakia
| | | | - Ivan Horvath
- Department of Cardiology, Health Faculty of Medicine, University of Pecs, Hungary
| | - John Davies
- Essex Cardiothoracic Centre, Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon, UK
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Metzler
- University Hospital of Internal Medicine lll/Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Andrejs Erglis
- Pauls Stradiņš Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Misa Fister
- University Medical Centre Ljubljana, Slovenia
| | - Gergely Nagy
- Borsod-Abauj-Zemplen County Central Hospital and University Teaching Hospital, 1st Department of Internal Medicine and Cardiology, Miskolc, Miskolc, Hungary
| | - Josko Bulum
- University Hospital Center Zagreb, Zagreb, Croatia
| | - István Édes
- Department of Cardiology, Faculty of Medicine, Medical and Health Science Center, University of Debrecen, Debrbrecen, Hungary
| | - Jan Peruga
- Medical University in Łódź, Bieganski Hospital, Łódź, Poland
| | - Beata Średniawa
- Silesian Center for Heart Diseases, Department of Cardiology, Medical University of Silesia, DMS in Zabrze, Zabrze, Poland
| | - David Erlinge
- Department of Cardiology, Lund University, Clinical Sciences, Skane University Hospital, Lund, Sweden
| | - Thomas R. Keeble
- Essex Cardiothoracic Centre, Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon, UK,Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
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32
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Schriefl C, Schoergenhofer C, Ettl F, Poppe M, Clodi C, Mueller M, Grafeneder J, Jilma B, Magnet IAM, Buchtele N, Boegl MS, Holzer M, Sterz F, Schwameis M. Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome. Front Med (Lausanne) 2021; 8:639803. [PMID: 34179033 PMCID: PMC8219926 DOI: 10.3389/fmed.2021.639803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permeability and may be associated with neurologic function after CA. Methods: We included patients ≥18 years, who suffered a non-traumatic CA between 2013 and 2018 from the prospective Vienna Clinical Cardiac Arrest Registry. Patients without return of spontaneous circulation (ROSC), with extracorporeal life support, with any form of bleeding, undergoing surgery, receiving transfusions, without targeted temperature management or with incomplete datasets for multivariable analysis were excluded. The primary outcome was neurologic function at day 30 assessed by the Cerebral Performance Category scale. Differences of hemoglobin concentrations at admission and 12 h after ROSC were calculated and associations with neurologic function were investigated by uni- and multivariable logistic regression. Results: Two hundred and seventy-five patients were eligible for analysis of which 143 (52%) had poor neurologic function. For every g/dl increase in hemoglobin from admission to 12 h the odds of poor neurologic function increased by 26% (crude OR 1.26, 1.07–1.49, p = 0.006). The effect remained unchanged after adjustment for fluid balance and traditional prognostication markers (adjusted OR 1.27, 1.05–1.54, p = 0.014). Conclusion: Increasing hemoglobin levels in spite of a positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function in the early post-cardiac arrest period.
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Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Juergen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Schade N, Koch P, Ansideri F, Krystof V, Holzer M, Hilgeroth A. Evaluation of Novel Substituted Furopyridines as Inhibitors of Protein Kinases Related to Tau Pathology in Alzheimer´s Disease. Med Chem 2021; 17:844-855. [PMID: 34061007 DOI: 10.2174/1573406417666210601144510] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/18/2021] [Accepted: 03/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alzheimer´s disease (AD) is characterized by a progressive neuronal degeneration caused by two pathological hallmarks, hyperphosphorylated tau protein aggregated into tau filaments and amyloid precursor protein derived beta amyloid peptides aggregated into extracellular amyloid plaques. All attempts so far to find effective drugs failed in clinical trials. AD is a multifactorial disease, so that selective drugs to target one AD-relevant structure alone may not be sufficient. OBJECTIVE We built novel furopyridines with various substitution patterns to evaluate them as protein kinases inhibitors of enzymes related to tau pathology. METHOD Furopyridine derivatives were synthesized and purified using column chromatography. The protein kinase inhibitory properties were determined in ATP-competition assays with determined affinity constants for the most active compounds. RESULTS The compounds were prepared in simple two-component reactions of substituted 1,4- dihydropyridines and respective quinones to obtain various substitutions of the molecular furopyridine scaffold. The substituent effects on the determined kinase inhibitory properties of cdk1, cdk2, Fyn, JNK3 and gsk-3β are discussed. CONCLUSION Various 3-substitutions were found most sensitive for the protein kinase inhibition depending on the length, nature and a substituent positioning within. We identified compounds as inhibitors of several kinases as a tool to potentially combat the disease progress in a multitargeting approach.
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Affiliation(s)
- N Schade
- Institute of Pharmacy, Martin-Luther-University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle, Germany
| | - P Koch
- Institute of Pharmaceutical Sciences, Eberhard-Karls-University Tübingen, Auf der Morgenstelle 8, 72076 Tübingen, Germany
| | - F Ansideri
- Institute of Pharmaceutical Sciences, Eberhard-Karls-University Tübingen, Auf der Morgenstelle 8, 72076 Tübingen, Germany
| | - V Krystof
- Laboratory of Growth Regulators, Palacky University, Slechtitelu 27, 78371 Olomouc. Czech Republic
| | - M Holzer
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany
| | - A Hilgeroth
- Institute of Pharmacy, Martin-Luther-University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle, Germany
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Trakaki A, Wolf P, Weger W, Eichmann TO, Scharnagl H, Stadler JT, Salmhofer W, Knuplez E, Holzer M, Marsche G. Biological anti-psoriatic therapy profoundly affects high-density lipoprotein function. Biochim Biophys Acta Mol Cell Biol Lipids 2021; 1866:158943. [PMID: 33862237 DOI: 10.1016/j.bbalip.2021.158943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
Psoriasis is a common chronic inflammatory skin disease linked to increased cardiovascular risk. Functional impairment of high-density lipoprotein (HDL) may contribute to excessive cardiovascular mortality in psoriasis patients. Anti-cytokine therapies with biologics have been efficiently used for the management of psoriasis, however little data is available on the effects of biologic anti-psoriatic therapies on the composition and functionality of HDL. Blood samples were taken from 17 healthy volunteers and from 27 real-world psoriasis patients at baseline (no therapy with biologics) and after short-term (3 to 6 months) and intermediate-term (1 to 2 years) therapy. The biologics used included anti-interleukin (IL)-12/23p40 (ustekinumab), anti-IL17A (secukinumab) or anti-tumor necrosis factor-α (etanercept or adalimumab) antibodies. We observed that in psoriasis patients at baseline, metrics of HDL function including cholesterol efflux capacity of apolipoprotein B-depleted serum (p = 0.021), paraoxonase (p < 0.001) and lecithin-cholesterol acyltransferase (p < 0.001) activities were impaired, when compared to controls. Unexpectedly, we observed that short- and especially intermediate-term therapy with biologics markedly reduced HDL cholesterol efflux capacity (p < 0.001) and rendered HDL pro-inflammatory (p < 0.001), but increased paraoxonase (p = 0.009) and lecithin-cholesterol acyltransferase (p = 0.019) activities. All biologics caused similar changes in HDL composition, subclass distribution and cholesterol efflux capacity. Our results provide evidence that anti-psoriatic therapy with biologic agents is associated with changes in HDL functionality, particle composition and subclass distribution.
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Affiliation(s)
- Athina Trakaki
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Peter Wolf
- Department of Dermatology and Venereology, Auenbruggerplatz 8, 8036 Graz, Austria.
| | - Wolfgang Weger
- Department of Dermatology and Venereology, Auenbruggerplatz 8, 8036 Graz, Austria
| | - Thomas O Eichmann
- Institute of Molecular Biosciences, University of Graz, Graz, Austria; Center for Explorative Lipidomics, BioTechMed-Graz, Graz, Austria
| | - Hubert Scharnagl
- Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Julia T Stadler
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Wolfgang Salmhofer
- Department of Dermatology and Venereology, Auenbruggerplatz 8, 8036 Graz, Austria
| | - Eva Knuplez
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Michael Holzer
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; BioTechMed Graz, Mozartgasse 12/II, 8010 Graz, Austria.
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Schilcher I, Stadler JT, Lechleitner M, Hrzenjak A, Berghold A, Pregartner G, Lhomme M, Holzer M, Korbelius M, Reichmann F, Springer A, Wadsack C, Madl T, Kratky D, Kontush A, Marsche G, Frank S. Endothelial Lipase Modulates Paraoxonase 1 Content and Arylesterase Activity of HDL. Int J Mol Sci 2021; 22:E719. [PMID: 33450841 PMCID: PMC7828365 DOI: 10.3390/ijms22020719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 01/26/2023] Open
Abstract
Endothelial lipase (EL) is a strong modulator of the high-density lipoprotein (HDL) structure, composition, and function. Here, we examined the impact of EL on HDL paraoxonase 1 (PON1) content and arylesterase (AE) activity in vitro and in vivo. The incubation of HDL with EL-overexpressing HepG2 cells decreased HDL size, PON1 content, and AE activity. The EL modification of HDL did not diminish the capacity of HDL to associate with PON1 when EL-modified HDL was incubated with PON1-overexpressing cells. The overexpression of EL in mice significantly decreased HDL serum levels but unexpectedly increased HDL PON1 content and HDL AE activity. Enzymatically inactive EL had no effect on the PON1 content of HDL in mice. In healthy subjects, EL serum levels were not significantly correlated with HDL levels. However, HDL PON1 content was positively associated with EL serum levels. The EL-induced changes in the HDL-lipid composition were not linked to the HDL PON1 content. We conclude that primarily, the interaction of enzymatically active EL with HDL, rather than EL-induced alterations in HDL size and composition, causes PON1 displacement from HDL in vitro. In vivo, the EL-mediated reduction of HDL serum levels and the consequently increased PON1-to-HDL ratio in serum increase HDL PON1 content and AE activity in mice. In humans, additional mechanisms appear to underlie the association of EL serum levels and HDL PON1 content.
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Affiliation(s)
- Irene Schilcher
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria; (I.S.); (M.L.); (M.K.); (A.S.); (T.M.); (D.K.)
| | - Julia T. Stadler
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (M.H.); (F.R.); (G.M.)
| | - Margarete Lechleitner
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria; (I.S.); (M.L.); (M.K.); (A.S.); (T.M.); (D.K.)
| | - Andelko Hrzenjak
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 16, 8036 Graz, Austria;
- Ludwig Boltzmann Institute for Lung Vascular Research, Stiftingtalstrasse 24, 8010 Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (A.B.); (G.P.)
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (A.B.); (G.P.)
| | - Marie Lhomme
- ICANalytics Lipidomics, Institute of Cardiometabolism and Nutrition, 75013 Paris, France;
| | - Michael Holzer
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (M.H.); (F.R.); (G.M.)
| | - Melanie Korbelius
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria; (I.S.); (M.L.); (M.K.); (A.S.); (T.M.); (D.K.)
| | - Florian Reichmann
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (M.H.); (F.R.); (G.M.)
| | - Anna Springer
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria; (I.S.); (M.L.); (M.K.); (A.S.); (T.M.); (D.K.)
| | - Christian Wadsack
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria;
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
| | - Tobias Madl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria; (I.S.); (M.L.); (M.K.); (A.S.); (T.M.); (D.K.)
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
| | - Dagmar Kratky
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria; (I.S.); (M.L.); (M.K.); (A.S.); (T.M.); (D.K.)
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
| | - Anatol Kontush
- INSERM Research Unit 1166—ICAN, Sorbonne University, 75013 Paris, France;
| | - Gunther Marsche
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; (J.T.S.); (M.H.); (F.R.); (G.M.)
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
| | - Saša Frank
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6/6, 8010 Graz, Austria; (I.S.); (M.L.); (M.K.); (A.S.); (T.M.); (D.K.)
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
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Baldi E, Schnaubelt S, Caputo ML, Klersy C, Clodi C, Bruno J, Compagnoni S, Benvenuti C, Domanovits H, Burkart R, Fracchia R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2021; 4:e2032875. [PMID: 33427885 PMCID: PMC7801935 DOI: 10.1001/jamanetworkopen.2020.32875] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Electrocardiography (ECG) is an important tool to triage patients with out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC). An immediate coronary angiography after ROSC is recommended only in patients with an ECG that is diagnostic of ST-segment elevation myocardial infarction (STEMI). To date, the benefit of this approach has not been demonstrated in patients with a post-ROSC ECG that is not diagnostic of STEMI. OBJECTIVE To assess whether the time from ROSC to ECG acquisition is associated with the diagnostic accuracy of ECG for STEMI. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study (the Post-ROSC Electrocardiogram After Cardiac Arrest study) analyzed consecutive patients older than 18 years who were resuscitated from OHCA between January 1, 2015, and December 31, 2018, and were admitted to 1 of the 3 participating centers in Europe (Pavia, Italy; Lugano, Switzerland; and Vienna, Austria). EXPOSURE Only patients who underwent coronary angiography during hospitalization and who acquired a post-ROSC ECG before the angiography were enrolled. Patients with a nonmedical cause of OHCAs were excluded. MAIN OUTCOMES AND MEASURES The primary end point was false-positive ECG findings, defined as the percentage of patients with post-ROSC ECG findings that met STEMI criteria but who did not show obstructive coronary artery disease on angiography that was worthy of percutaneous coronary angioplasty. RESULTS Of 586 consecutive patients who were admitted to the 3 participating centers, 370 were included in the analysis (287 men [77.6%]; median age, 62 years [interquartile range, 53-70 years]); 121 (32.7%) were enrolled in the participating center in Pavia, Italy; 38 (10.3%) in Lugano, Switzerland; and 211 (57.0%) in Vienna, Austria. The percentage of false-positive ECG findings in the first tertile of ROSC to ECG time (≤7 minutes) was significantly higher than that in the second (8-33 minutes) and third (>33 minutes) tertiles: 18.5% in the first tertile vs 7.2% in the second (odds ratio [OR], 0.34; 95% CI, 0.13-0.87; P = .02) and 5.8% in the third (OR, 0.27; 95% CI, 0.15-0.47; P < .001). These differences remained significant when adjusting for sex (≤7 minutes: reference; 8-33 minutes: OR, 0.32; 95% CI, 0.12-0.85; P = .02; >33 minutes: OR, 0.26; 95% CI, 0.14-0.47; P < .001), age (≤7 minutes: reference; 8-33 minutes: OR, 0.34; 95% CI, 0.13-0.89; P = .03; >33 minutes: OR, 0.27; 95% CI, 0.15-0.46; P < .001), number of segments with ST-elevation (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.15-0.81; P = .01; >33 minutes: OR, 0.28; 95% CI, 0.15-0.52; P < .001), QRS duration (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.14-0.87; P = .02; >33 minutes: OR, 0.27; 95% CI, 0.15-0.48; P < .001), heart rate (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.13-0.93; P = .04; >33 minutes: OR, 0.29; 95% CI, 0.15-0.55; P < .001), epinephrine administered (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.13-0.98; P = .045; >33 minutes: OR, 0.27; 95% CI, 0.16-0.48; P < .001), shockable initial rhythm (≤7 minutes: reference; 8-33 minutes: OR, 0.35; 95% CI, 0.13-0.96; P = .04; >33 minutes: OR, 0.26; 95% CI, 0.15-0.46; P < .001), and 3 or more shocks administered (≤7 minutes: reference; 8-33 minutes: OR, 0.36; 95% CI, 0.13-1.00; P = .05; >33 minutes: OR, 0.27; 95% CI, 0.16-0.48; P < .001) in bivariable analyses. CONCLUSIONS AND RELEVANCE This study suggests that early ECG acquisition after ROSC in patients with OHCA is associated with a higher percentage of false-positive ECG findings for STEMI. It may be reasonable to delay post-ROSC ECG by at least 8 minutes after ROSC or repeat the acquisition if the first ECG is diagnostic of STEMI and is acquired early after ROSC.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | - Maria Luce Caputo
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Jolie Bruno
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Rosa Fracchia
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gerhard Ruzicka
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Schriefl C, Schoergenhofer C, Grafeneder J, Poppe M, Clodi C, Mueller M, Ettl F, Jilma B, Wallmueller P, Buchtele N, Weikert C, Losert H, Holzer M, Sterz F, Schwameis M. Prolonged Activated Partial Thromboplastin Time after Successful Resuscitation from Cardiac Arrest is Associated with Unfavorable Neurologic Outcome. Thromb Haemost 2020; 121:477-483. [PMID: 33186992 DOI: 10.1055/s-0040-1719029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Coagulation abnormalities after successful resuscitation from cardiac arrest may be associated with unfavorable neurologic outcome. We investigated a potential association of activated partial thromboplastin time (aPTT) with neurologic outcome in adult cardiac arrest survivors. Therefore, we included all adults ≥18 years of age who suffered a nontraumatic cardiac arrest and had achieved return of spontaneous circulation between January 2013 and December 2018. Patients receiving anticoagulants or thrombolytic therapy and those subjected to extracorporeal membrane oxygenation support were excluded. Routine blood sampling was performed on admission as soon as a vascular access was available. The primary outcome was 30-day neurologic function, assessed by the Cerebral Performance Category scale (3-5 = unfavorable neurologic function). Multivariable regression was used to assess associations between normal (≤41 seconds) and prolonged (>41 seconds) aPTT on admission (exposure) and the primary outcome. Results are given as odds ratio (OR) with 95% confidence intervals (95% CIs). Out of 1,591 cardiac arrest patients treated between 2013 and 2018, 360 patients (32% female; median age: 60 years [interquartile range: 48-70]) were eligible for analysis. A total of 263 patients (73%) had unfavorable neurologic function at day 30. aPTT prolongation >41 seconds was associated with a 190% increase in crude OR of unfavorable neurologic function (crude OR: 2.89; 95% CI: 1.78-4.68, p < 0.001) and with more than double the odds after adjustment for traditional risk factors (adjusted OR: 2.01; 95% CI: 1.13-3.60, p = 0.018). In conclusion, aPTT prolongation on admission is associated with unfavorable neurologic outcome after successful resuscitation from cardiac arrest.
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Affiliation(s)
| | | | - Juergen Grafeneder
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Pia Wallmueller
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Austria
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Baldi E, Schnaubelt S, Caputo M, Klersy C, Clodi C, Bruno J, Compagnoni S, Benvenuti C, Burkart R, Fracchia R, Holzer M, Auricchio A, Savastano S. Post-ROSC electrocardiogram timing in the management of out-of-hospital cardiac arrest: results of an international multicentric study (PEACE study). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1851] [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
Electrocardiogram (ECG) is a key tool to triage out-of-hospital cardiac arrest (OHCA) patients after achieving a sustained return of spontaneous circulation (ROSC). According to current guidelines, an immediate coronary angiography is indicated only when the post-ROSC ECG discloses a ST-elevation myocardial Infarction (STEMI). Moreover, the 12-lead ECG should be recorded as soon as possible after ROSC, although it is reasonable that in the early post-ROSC stages ECG could reflect the ischemia secondary to cardiac arrest besides that of coronary origin possibly causing an overdiagnosis of STEMI (false positive).
Purpose
To assess whether the time from ROSC to ECG acquisition could affect the percentage of false positive ECG for STEMI.
Methods
We performed a retrospective, international, multicenter study (PEACE Study - NCT04096079). We included all patients over 18 years of age hospitalized after an OHCA due to medical cause at one of the three participating high-volume hospitals of three different European countries between 2015, 1st January and 2018, 31st December. We considered for the present study only patients who underwent coronary angiography and in whom a post-ROSC ECG was available. For the electrocardiographic diagnosis of STEMI the criteria established by the ESC 2017 guidelines were used, while the execution of a percutaneous coronary angioplasty (PTCA) was evaluated as an angiographic endpoint. We used logistic regression to evaluate the association of time to acquisition and the endpoint. We computed odds ratios and 95% confidence intervals (OR, 95% CI).
Results
Population consisted of 370 patients (77.6% male, mean age 61±13 years, median ROSC-ECG time 15 minutes). Post-ROSC ECG was positive for STEMI in 198 patients and in 39 of them (10.5%) a PTCA was not performed during urgent coronary angiography, representing the false positive (FP) ECG. Dividing the population in three tertiles according to the time from ROSC to ECG (≤7 mins; 8–33 mins; >33 mins), the percentage of FP-ECG in the first tertile (18.5%) was statistically significantly higher than in the second (7.2%, OR 2.9 (95% CI 1.1–7.5) p=0.025) and third (5.8%, OR 3.7 (95% CI 2.2–6.5) p<0.001) as also shown in the Figure. These differences remained significant when adjusting for sex, age, number of segments involved at ECG (anterior, lateral, posterior, inferior and right), QRS duration >120 msec, ECG heart rate >100 bpm and adrenaline administered >1 mg.
Conclusion
Our study offers the first demonstration that the acquisition of the 12-leads ECG too early after ROSC can misleadingly lead to the diagnosis of STEMI. Despite further validation are required, our data suggest that it may be reasonable to delay the acquisition of the ECG at least 8 minutes after ROSC or to repeat the acquisition if the first ECG, resulting diagnostic for STEMI, was performed very early.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Baldi
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - S Schnaubelt
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | - M.L Caputo
- Cardiocentro Ticino, Lugano, Switzerland
| | - C Klersy
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - C Clodi
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | - J Bruno
- Cardiocentro Ticino, Lugano, Switzerland
| | - S Compagnoni
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | | | - R Burkart
- Fondazione TicinoCuore, Lugano, Switzerland
| | - R Fracchia
- Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy
| | - M Holzer
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | | | - S Savastano
- Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy
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Poppe M, Krammel M, Clodi C, Schriefl C, Warenits AM, Nürnberger A, Losert H, Girsa M, Holzer M, Weiser C. Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial. European Heart Journal. Acute Cardiovascular Care 2020; 9:S82-S89. [DOI: 10.1177/2048872620925681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective
Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest.
Methods
All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study.
Results
Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96).
Conclusion
An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.
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Affiliation(s)
- Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Mario Krammel
- Emergency Medical Service of Vienna, Vienna, Austria
- PULS – Austrian Cardiac Awareness Association, Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- PULS – Austrian Cardiac Awareness Association, Vienna, Austria
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- PULS – Austrian Cardiac Awareness Association, Vienna, Austria
| | | | | | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Girsa
- Emergency Medical Service of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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40
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Mueller M, Schriefl C, Holzer M, Roeggla M, Laggner AN, Ettl F. Education in Academic Emergency Medicine During the COVID-19 Pandemic - Our Experience From an Ongoing Crisis. Front Public Health 2020; 8:592503. [PMID: 33194997 PMCID: PMC7664155 DOI: 10.3389/fpubh.2020.592503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 pandemic has resulted in the suspension of the entire teaching program at the Medical University of Vienna till the end of the summer semester. As the department that is responsible for emergency medicine teaching, we adapted the program to continue the courses and maintain the learning progress. Our objective is to evaluate the number of courses conducted and report the methods used. Methods: Teaching was measured as credit hours per week (CHW) in accordance with the university's prospectus. One CHW represents 15 academic hours (45 min) in one semester. Webinars were conducted using the CISCO Webex Events®, Webex Training, and ZOOM®. The Moodle® was utilized for resuscitation courses. Results: Courses and clerkships equivalent to 80.2 out of 101.4 CHW (79.1%) could be held during the ongoing crisis in the summer semester. Courses in the winter semester were all completed. In the human medicine curriculum, 73.7 out of 94.9 CHW (77.7%) could be conducted. In the case of emergency lectures for the dentistry curriculum, all courses were conducted through webinars (6.5 CHW, 100%). After calculating the exact number of students in each class, it has been determined that courses and clerkships equivalent to 78.7% could be conducted. Conclusion: Despite the challenge of preparing for the treatment of numerous patients during the ongoing pandemic, we could shoulder a majority of our teaching responsibilities. Although sufficient skill training could not be imparted under these circumstances, we could provide sufficient theoretical knowledge to allow students to continue studies.
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Affiliation(s)
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Reisinger AC, Schuller M, Holzer M, Stadler JT, Hackl G, Posch F, Marsche G, Sourij H, Ekart R, Eller K, Eller P. Arylesterase Activity of HDL Associated Paraoxonase as a Potential Prognostic Marker in Patients With Sepsis and Septic Shock-A Prospective Pilot Study. Front Med (Lausanne) 2020; 7:579677. [PMID: 33195328 PMCID: PMC7642222 DOI: 10.3389/fmed.2020.579677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background: High-density lipoprotein (HDL) plays an essential role in the immune system and shows effective antioxidative properties. We investigated correlations of lipid parameters with the sequential organ failure assessment (SOFA) score and the prognostic association with mortality in sepsis patients admitted to intensive care unit (ICU). Methods: We prospectively recruited consecutive adult patients with sepsis and septic shock, according to sepsis-3 criteria as well as non-sepsis ICU controls. Results: Fifty-three patients with sepsis (49% with septic shock) and 25 ICU controls without sepsis were enrolled. Dyslipidemia (HDL-C < 40 mg/l) was more common in sepsis compared to non-sepsis patients (85 vs. 52%, p = 0.002). Septic patients compared to controls had reduced HDL-C (14 vs. 39 mg/l, p < 0.0001), lower arylesterase activity of the antioxidative paraoxonase of HDL (AEA) (67 vs. 111 mM/min/ml serum, p < 0.0001), and a non-significant trend toward reduced cholesterol efflux capacity (9 vs. 10%, p = 0.091). We observed a strong association between higher AEA and lower risk of 28-day [per 10 mM/min/ml serum increase in AEA: odds ratio (OR) = 0.76; 95% CI, 0.61-0.94; p = 0.01) and ICU mortality (per 10 mM/min/ml serum increase in AEA: OR = 0.71, 95% CI, 0.56-0.90, p = 0.004) in the sepsis cohort in univariable logistic regression analysis. AEA was confirmed as an independent predictor of 28-day and ICU mortality in multivariable analyses. AEA discriminated well-regarding 28-day/ICU mortality in area under the receiver operating characteristic curve (AUROC) analyses. In survival analysis, 28-day mortality estimates were 40 and 69% with AEA ≥/< the 25th percentile of AEA's distribution, respectively (log-rank p = 0.0035). Conclusions: Both compositional and functional HDL parameters are profoundly altered during sepsis. In particular, the functionality parameter AEA shows promising prognostic potential in sepsis patients.
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Affiliation(s)
- Alexander C. Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Max Schuller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Holzer
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
| | - Julia T. Stadler
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, University Clinical Centre Maribor, Maribor, Slovenia
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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42
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Trakaki A, Scharnagl H, Trieb M, Holzer M, Hinghofer-Szalkay H, Goswami N, Marsche G. Prolonged bedrest reduces plasma high-density lipoprotein levels linked to markedly suppressed cholesterol efflux capacity. Sci Rep 2020; 10:15001. [PMID: 32929107 PMCID: PMC7490699 DOI: 10.1038/s41598-020-71921-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/31/2020] [Accepted: 08/21/2020] [Indexed: 12/19/2022] Open
Abstract
Recent observations strongly connect high-density lipoproteins (HDL) function and levels with coronary heart disease outcomes and risk for infections and sepsis. To date, our knowledge of factors determining this connection is still very limited. The immobility associated with prolonged bedrest is detrimental to health, affecting several systems, including the cardiovascular, pulmonary, gastrointestinal, musculoskeletal and urinary. Effects of prolonged bedrest on the composition and functional properties of HDL remain elusive. We evaluated metrics of HDL composition and function in healthy male volunteers participating in a randomized, crossover head-down bedrest study. We observed that HDL cholesterol efflux capacity was profoundly decreased during bedrest, mediated by a bedrest associated reduction in plasma levels of HDL-cholesterol and major apolipoproteins (apo) apoA-I and apoA-II. Paraoxonase activity, plasma anti-oxidative capacity and the activities of lecithin-cholesterol acyltransferase and cholesteryl ester transfer protein were not affected. No change was observed in the content of HDL-associated serum amyloid A, a sensitive marker of inflammation. Resistive vibration exercise countermeasure during bedrest did not correct impaired cholesterol efflux capacity and only tended to increase arylesterase activity of HDL-associated paraoxonase. In conclusion, prolonged bedrest reduces plasma HDL levels linked to markedly suppressed HDL cholesterol efflux capacity. Resistive vibration exercise during bedrest did not correct HDL levels and impaired cholesterol efflux capacity.
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Affiliation(s)
- Athina Trakaki
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Hubert Scharnagl
- Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Markus Trieb
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria.,BioTechMed Graz, Mozartgasse 12/II, 8010, Graz, Austria
| | - Michael Holzer
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Helmut Hinghofer-Szalkay
- Division of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6/D-5, 8010, Graz, Austria
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6/D-5, 8010, Graz, Austria.
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria. .,BioTechMed Graz, Mozartgasse 12/II, 8010, Graz, Austria.
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43
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Warenits AM, Hatami J, Müllebner A, Ettl F, Teubenbacher U, Magnet IAM, Bauder B, Janata A, Miller I, Moldzio R, Kramer AM, Sterz F, Holzer M, Högler S, Weihs W, Duvigneau JC. Motor Cortex and Hippocampus Display Decreased Heme Oxygenase Activity 2 Weeks After Ventricular Fibrillation Cardiac Arrest in Rats. Front Med (Lausanne) 2020; 7:513. [PMID: 33015090 PMCID: PMC7511667 DOI: 10.3389/fmed.2020.00513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/24/2020] [Indexed: 01/07/2023] Open
Abstract
Heme oxygenase (HO) and biliverdin reductase (BVR) activities are important for neuronal function and redox homeostasis. Resuscitation from cardiac arrest (CA) frequently results in neuronal injury and delayed neurodegeneration that typically affect vulnerable brain regions, primarily hippocampus (Hc) and motor cortex (mC), but occasionally also striatum and cerebellum. We questioned whether these delayed effects are associated with changes of the HO/BVR system. We therefore analyzed the activities of HO and BVR in the brain regions Hc, mC, striatum and cerebellum of rats subjected to ventricular fibrillation CA (6 min or 8 min) after 2 weeks following resuscitation, or sham operation. From all investigated regions, only Hc and mC showed significantly decreased HO activities, while BVR activity was not affected. In order to find an explanation for the changed HO activity, we analyzed protein abundance and mRNA expression levels of HO-1, the inducible, and HO-2, the constitutively expressed isoform, in the affected regions. In both regions we found a tendency for a decreased immunoreactivity of HO-2 using immunoblots and immunohistochemistry. Additionally, we investigated the histological appearance and the expression of markers indicative for activation of microglia [tumor necrosis factor receptor type I (TNFR1) mRNA and immunoreactivity for ionized calcium-binding adapter molecule 1 (Iba1])], and activation of astrocytes [immunoreactivity for glial fibrillary acidic protein (GFAP)] in Hc and mC. Morphological changes were detected only in Hc displaying loss of neurons in the cornu ammonis 1 (CA1) region, which was most pronounced in the 8 min CA group. In this region also markers indicating inflammation and activation of pro-death pathways (expression of HO-1 and TNFR1 mRNA, as well as Iba1 and GFAP immunoreactivity) were upregulated. Since HO products are relevant for maintaining neuronal function, our data suggest that neurodegenerative processes following CA may be associated with a decreased capacity to convert heme into HO products in particularly vulnerable brain regions.
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Affiliation(s)
| | - Jasmin Hatami
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Andrea Müllebner
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria.,Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Ursula Teubenbacher
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | | | - Barbara Bauder
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - Andreas Janata
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Miller
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Rudolf Moldzio
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandra Högler
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weihs
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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44
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Ljubojevic-Holzer S, Herren AW, Djalinac N, Voglhuber J, Morotti S, Holzer M, Wood BM, Abdellatif M, Matzer I, Sacherer M, Radulovic S, Wallner M, Ivanov M, Wagner S, Sossalla S, von Lewinski D, Pieske B, Brown JH, Sedej S, Bossuyt J, Bers DM. CaMKIIδC Drives Early Adaptive Ca 2+ Change and Late Eccentric Cardiac Hypertrophy. Circ Res 2020; 127:1159-1178. [PMID: 32821022 PMCID: PMC7547876 DOI: 10.1161/circresaha.120.316947] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. CaMKII (Ca2+-Calmodulin dependent protein kinase) δC activation is implicated in pathological progression of heart failure (HF) and CaMKIIδC transgenic mice rapidly develop HF and arrhythmias. However, little is known about early spatio-temporal Ca2+ handling and CaMKII activation in hypertrophy and HF.
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Affiliation(s)
- Senka Ljubojevic-Holzer
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria.,Department of Pharmacology, University of California, Davis, CA (S.L.-H., A.W.H., S.M., B.M.W., J.B., D.M.B.).,BioTechMed Graz, Austria (S.L.-H., J.V., S. Sedej)
| | - Anthony W Herren
- Department of Pharmacology, University of California, Davis, CA (S.L.-H., A.W.H., S.M., B.M.W., J.B., D.M.B.)
| | - Natasa Djalinac
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria
| | - Julia Voglhuber
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria.,BioTechMed Graz, Austria (S.L.-H., J.V., S. Sedej)
| | - Stefano Morotti
- Department of Pharmacology, University of California, Davis, CA (S.L.-H., A.W.H., S.M., B.M.W., J.B., D.M.B.)
| | - Michael Holzer
- Otto-Loewi Research Centre, Division of Pharmacology (M.H.), Medical University of Graz, Austria
| | - Brent M Wood
- Department of Pharmacology, University of California, Davis, CA (S.L.-H., A.W.H., S.M., B.M.W., J.B., D.M.B.)
| | - Mahmoud Abdellatif
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria
| | - Ingrid Matzer
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria
| | - Michael Sacherer
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria
| | - Snjezana Radulovic
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria
| | - Markus Wallner
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria
| | - Milan Ivanov
- Institute for Medical Research, University of Belgrade, Serbia (M.I.)
| | - Stefan Wagner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (S.W., S. Sossalla)
| | - Samuel Sossalla
- Klinik für Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Germany (S. Sossalla).,Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany (S.W., S. Sossalla)
| | - Dirk von Lewinski
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Germany (B.P.)
| | - Joan Heller Brown
- Department of Pharmacology, University of California San Diego, La Jolla (J.H.B.)
| | - Simon Sedej
- Department of Cardiology (S.L.-H., N.D., J.V., M.A., I.M., M.S., S.R., M.W., D.v.L., S. Sedej), Medical University of Graz, Austria.,BioTechMed Graz, Austria (S.L.-H., J.V., S. Sedej).,Faculty of Medicine, Institute of Physiology, University of Maribor, Slovenia (S. Sedej)
| | - Julie Bossuyt
- Department of Pharmacology, University of California, Davis, CA (S.L.-H., A.W.H., S.M., B.M.W., J.B., D.M.B.)
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis, CA (S.L.-H., A.W.H., S.M., B.M.W., J.B., D.M.B.)
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45
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Wiedemann D, Bernardi MH, Distelmaier K, Goliasch G, Hengstenberg C, Hermann A, Holzer M, Hoetzenecker K, Klepetko W, Lang G, Lassnigg A, Laufer G, Magnet IAM, Markstaller K, Röggla M, Rössler B, Schellongowski P, Simon P, Tschernko E, Ullrich R, Zimpfer D, Staudinger T. Recommendations for extracorporeal membrane oxygenation (ECMO) in COVID-19 patients : Consensus paper of the Medical University of Vienna. Wien Klin Wochenschr 2020; 132:671-676. [PMID: 32621065 PMCID: PMC7332739 DOI: 10.1007/s00508-020-01708-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 01/10/2023]
Abstract
The pandemic from the SARS-CoV‑2 virus is currently challenging healthcare systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to guarantee a safe working environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeutic option in patients with severe heart or lung failure. Although only a limited proportion of COVID-19 patients develop respiratory or circulatory failure that is refractory to conventional treatment, it is of utmost importance to clearly define criteria for the use of ECMO in this steadily growing patient population. The ECMO working group of the Medical University of Vienna has established the following recommendations for ECMO support in COVID-19 patients.
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Affiliation(s)
- Dominik Wiedemann
- Division of Cardiac Surgery, University Department of Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Martin H Bernardi
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, University Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Distelmaier
- Division of Cardiology, University Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Division of Cardiology, University Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, University Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alexander Hermann
- University Department of Medicine I, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Holzer
- University Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - György Lang
- Division of Thoracic Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Andrea Lassnigg
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, University Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Division of Cardiac Surgery, University Department of Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ingrid A M Magnet
- University Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Markstaller
- Medical Simulation and Emergency Management Research Group, Medical University of Vienna, Vienna, Austria
| | - Martin Röggla
- University Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Rössler
- Medical Simulation and Emergency Management Research Group, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- University Department of Medicine I, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Paul Simon
- Division of Cardiac Surgery, University Department of Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, University Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- Medical Simulation and Emergency Management Research Group, Medical University of Vienna, Vienna, Austria.,Division of General Anaesthesia and Intensive Care Medicine, University Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, University Department of Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Staudinger
- University Department of Medicine I, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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46
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Wiedemann D, Bernardi MH, Distelmaier K, Goliasch G, Hengstenberg C, Hermann A, Holzer M, Hoetzenecker K, Klepetko W, Lang G, Lassnigg A, Laufer G, Magnet IAM, Markstaller K, Röggla M, Rössler B, Schellongowski P, Simon P, Tschernko E, Ullrich R, Zimpfer D, Staudinger T. [Recommendations for Extracorporeal Membrane Oxygenation (ECMO) in COVID-19 Patients]. Wien Klin Mag 2020; 23:168-173. [PMID: 32837601 PMCID: PMC7286215 DOI: 10.1007/s00740-020-00349-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The pandemic from the SARS-CoV‑2 Virus is currently challenging health care systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to guarantee a safe work environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeutic option in patients with severe heart or lung failure. Although only a limited proportion of COVID-19 patients develops respiratory or circulatory failure that is refractory to conventional therapies, it is of utmost importance to clearly define criteria for the use of ECMOs in this steadily growing patient population. The ECMO working group of the Medical University of Vienna has established the following recommendations for ECMO support in COVID-19 patients.
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Affiliation(s)
- Dominik Wiedemann
- Klinische Abteilung für Herzchirurgie, Universitätsklinik für Chirurgie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Martin H. Bernardi
- Allgemeine Intensivmedizin und Schmerztherapie, Klinische Abteilung für Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
| | - Klaus Distelmaier
- Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien, Wien, Österreich
| | - Georg Goliasch
- Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien, Wien, Österreich
| | - Christian Hengstenberg
- Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Hermann
- Universitätsklinik für Innere Medizin I, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Michael Holzer
- Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Konrad Hoetzenecker
- Klinische Abteilung für Thoraxchirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Walter Klepetko
- Klinische Abteilung für Thoraxchirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - György Lang
- Klinische Abteilung für Thoraxchirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Andrea Lassnigg
- Allgemeine Intensivmedizin und Schmerztherapie, Klinische Abteilung für Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
| | - Günther Laufer
- Klinische Abteilung für Herzchirurgie, Universitätsklinik für Chirurgie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Ingrid A. M. Magnet
- Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Klaus Markstaller
- Allgemeine Intensivmedizin und Schmerztherapie, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
| | - Martin Röggla
- Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Bernhard Rössler
- Allgemeine Intensivmedizin und Schmerztherapie, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
- Medizinisches Simulationszentrum, Universitätsklinik für Anästhesie, Wien, Österreich
| | - Peter Schellongowski
- Universitätsklinik für Innere Medizin I, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Paul Simon
- Klinische Abteilung für Herzchirurgie, Universitätsklinik für Chirurgie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Edda Tschernko
- Allgemeine Intensivmedizin und Schmerztherapie, Klinische Abteilung für Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
| | - Roman Ullrich
- Allgemeine Intensivmedizin und Schmerztherapie, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
| | - Daniel Zimpfer
- Klinische Abteilung für Herzchirurgie, Universitätsklinik für Chirurgie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Thomas Staudinger
- Universitätsklinik für Innere Medizin I, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - COVID-19 ECMO Arbeitsgruppe Medizinische Universität Wien
- Klinische Abteilung für Herzchirurgie, Universitätsklinik für Chirurgie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
- Allgemeine Intensivmedizin und Schmerztherapie, Klinische Abteilung für Herz-Thorax-Gefäßchirurgische Anästhesie und Intensivmedizin, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Innere Medizin II, Klinische Abteilung für Kardiologie, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Innere Medizin I, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
- Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Wien, Österreich
- Klinische Abteilung für Thoraxchirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Wien, Wien, Österreich
- Allgemeine Intensivmedizin und Schmerztherapie, Universitätsklinik für Anästhesie, Medizinische Universität Wien, Wien, Österreich
- Medizinisches Simulationszentrum, Universitätsklinik für Anästhesie, Wien, Österreich
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Knuplez E, Curcic S, Theiler A, Bärnthaler T, Trakaki A, Trieb M, Holzer M, Heinemann A, Zimmermann R, Sturm EM, Marsche G. Lysophosphatidylcholines inhibit human eosinophil activation and suppress eosinophil migration in vivo. Biochim Biophys Acta Mol Cell Biol Lipids 2020; 1865:158686. [PMID: 32171907 DOI: 10.1016/j.bbalip.2020.158686] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023]
Abstract
Eosinophils are important multifaceted effector cells involved in allergic inflammation. Following allergen challenge, eosinophils and other immune cells release secreted phospholipases, generating lysophosphatidylcholines (LPCs). LPCs are potent lipid mediators, and serum levels of LPCs associate with asthma severity, suggesting a regulatory activity of LPCs in asthma development. As of yet, the direct effects of LPCs on eosinophils remain unclear. In the present study, we tested the effects of the major LPC species (16:0, 18:0 and 18:1) on eosinophils isolated from healthy human donors. Addition of saturated LPCs in the presence of albumin rapidly disrupted cholesterol-rich nanodomains on eosinophil cell membranes and suppressed multiple eosinophil effector responses, such as CD11b upregulation, degranulation, chemotaxis, and downstream signaling. Furthermore, we demonstrate in a mouse model of allergic cell recruitment, that LPC treatment markedly reduces immune cell infiltration into the lungs. Our observations suggest a strong modulatory activity of LPCs in the regulation of eosinophilic inflammation in vitro and in vivo.
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Affiliation(s)
- Eva Knuplez
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Sanja Curcic
- Division of Biophysics, Gottfried-Schatz-Research-Center, Medical University of Graz, Neue Stiftingtalstrasse 6/D04, 8010 Graz, Austria
| | - Anna Theiler
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Thomas Bärnthaler
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Athina Trakaki
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Markus Trieb
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; BioTechMed-Graz, Graz, Austria
| | - Michael Holzer
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; BioTechMed-Graz, Graz, Austria
| | - Akos Heinemann
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; BioTechMed-Graz, Graz, Austria
| | - Robert Zimmermann
- BioTechMed-Graz, Graz, Austria; Institute of Molecular Biosciences, University of Graz, Graz, Austria
| | - Eva M Sturm
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria; BioTechMed-Graz, Graz, Austria.
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Bartlett ES, Valenzuela T, Idris A, Deye N, Glover G, Gillies MA, Taccone FS, Sunde K, Flint AC, Thiele H, Arrich J, Hemphill C, Holzer M, Skrifvars MB, Pittl U, Polderman KH, Ong MEH, Kim KH, Oh SH, Do Shin S, Kirkegaard H, Nichol G. Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest. Resuscitation 2019; 146:82-95. [PMID: 31730898 DOI: 10.1016/j.resuscitation.2019.10.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Received: 04/03/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically review the effectiveness and safety of intravascular temperature management (IVTM) vs. surface cooling methods (SCM) for induced hypothermia (IH). METHODS Systematic review and meta-analysis. English-language PubMed, Embase and the Cochrane Database of Systematic Reviews were searched on May 27, 2019. The quality of included observational studies was graded using the Newcastle-Ottawa Quality Assessment tool. The quality of included randomized trials was evaluated using the Cochrane Collaboration's risk of bias tool. Random effects modeling was used to calculate risk differences for each outcome. Statistical heterogeneity and publication bias were assessed using standard methods. ELIGIBILITY Observational or randomized studies comparing survival and/or neurologic outcomes in adults aged 18 years or greater resuscitated from out-of-hospital cardiac arrest receiving IH via IVTM vs. SCM were eligible for inclusion. RESULTS In total, 12 studies met inclusion criteria. These enrolled 1573 patients who received IVTM; and 4008 who received SCM. Survival was 55.0% in the IVTM group and 51.2% in the SCM group [pooled risk difference 2% (95% CI -1%, 5%)]. Good neurological outcome was achieved in 40.9% in the IVTM and 29.5% in the surface group [pooled risk difference 5% (95% CI 2%, 8%)]. There was a 6% (95% CI 11%, 2%) lower risk of arrhythmia with use of IVTM and 15% (95% CI 22%, 7%) decreased risk of overcooling with use of IVTM vs. SCM. There was no significant difference in other evaluated adverse events between groups. CONCLUSIONS IVTM was associated with improved neurological outcomes vs. SCM among survivors resuscitated following cardiac arrest. These results may have implications for care of patients in the emergency department and intensive care settings after resuscitation from cardiac arrest.
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Affiliation(s)
- Emily S Bartlett
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States.
| | - Terence Valenzuela
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, United States; Tucson Fire Department, Tucson, AZ, United States
| | - Ahamed Idris
- Departments of Emergency and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nicolas Deye
- Medical Intensive Care Unit, Inserm U942, Lariboisiere Hospital, APHP, F-75010, Paris, France
| | - Guy Glover
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael A Gillies
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fabio S Taccone
- Department of Intensive Care, Cliniques Universitaires de Bruxelles Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alexander C Flint
- Divison of Research, Kaiser Permanente, Oakland, CA, United States; Neuroscience Department, Kaiser Permanente, Redwood City, CA, United States
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jasmin Arrich
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Center of Emergency Medicine, University of Jena, Faculty of Medicine, Jena, Germany
| | - Claude Hemphill
- Department of Neurology, University of California, San Francisco, CA, United States
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Undine Pittl
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Kees H Polderman
- Essex Cardiothoracic Centre, Basildon, Essex, SS16 5NL, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, CM1 1SQ, United Kingdom; United General Hospital, Houston, TX, United States
| | - Marcus E H Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Department of Emergency Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States; Department of Internal Medicine, University of Washington, Seattle, WA, United States; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, United States
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49
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Clodi C, Schriefl C, Poppe M, Warenits AM, Nuernberger A, Kießlinger M, Zajicek A, Klune G, Holzer M, Weiser C. The transport in medical emergency simulation study (TIME-Sim). Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Maki RA, Holzer M, Motamedchaboki K, Malle E, Masliah E, Marsche G, Reynolds WF. Human myeloperoxidase (hMPO) is expressed in neurons in the substantia nigra in Parkinson's disease and in the hMPO-α-synuclein-A53T mouse model, correlating with increased nitration and aggregation of α-synuclein and exacerbation of motor impairment. Free Radic Biol Med 2019; 141:115-140. [PMID: 31175983 PMCID: PMC6774439 DOI: 10.1016/j.freeradbiomed.2019.05.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
α-Synuclein (αSyn) is central to the neuropathology of Parkinson's disease (PD) due to its propensity for misfolding and aggregation into neurotoxic oligomers. Nitration/oxidation of αSyn leads to dityrosine crosslinking and aggregation. Myeloperoxidase (MPO) is an oxidant-generating enzyme implicated in neurodegenerative diseases. In the present work we have examined the impact of MPO in PD through analysis of postmortem PD brain and in a novel animal model in which we crossed a transgenic mouse expressing the human MPO (hMPO) gene to a mouse expressing human αSyn-A53T mutant (A53T) (hMPO-A53T). Surprisingly, our results show that in PD substantia nigra, the hMPO gene is expressed in neurons containing aggregates of nitrated αSyn as well as MPO-generated HOCl-modified epitopes. In our hMPO-A53T mouse model, we also saw hMPO expression in neurons but not mouse MPO. In the mouse model, hMPO was expressed in neurons colocalizing with nitrated αSyn, carbamylated lysine, nitrotyrosine, as well as HOCl-modified epitopes/proteins. RNAscope in situ hybridization confirmed hMPO mRNA expression in neurons. Interestingly, the hMPO protein expressed in hMPO-A53T brain is primarily the precursor proMPO, which enters the secretory pathway potentially resulting in interneuronal transmission of MPO and oxidative species. Importantly, the hMPO-A53T mouse model, when compared to the A53T model, exhibited significant exacerbation of motor impairment on rotating rods, balance beams, and wire hang tests. Further, hMPO expression in the A53T model resulted in earlier onset of end stage paralysis. Interestingly, there was a high concentration of αSyn aggregates in the stratum lacunosum moleculare of hippocampal CA2 region, which has been associated in humans with accumulation of αSyn pathology and neural atrophy in dementia with Lewy bodies. This accumulation of αSyn aggregates in CA2 was associated with markers of endoplasmic reticulum (ER) stress and the unfolded protein response with expression of activating transcription factor 4 (ATF4), C/EBP homologous protein (CHOP), MPO, and cleaved caspase-3. Together these findings suggest that MPO plays an important role in nitrative and oxidative damage that contributes to αSyn pathology in synucleinopathies.
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Affiliation(s)
- Richard A Maki
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Michael Holzer
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Austria
| | - Khatereh Motamedchaboki
- Tumor Initiation & Maintenance Program and NCI Cancer Centre Proteomics Facility, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Ernst Malle
- Gottfried Schatz Research Center, Division of Molecular Biology and Biochemistry, Medical University of Graz, Austria
| | - Eliezer Masliah
- Molecular Neuropathology Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, 20892, USA; Department Neurosciences, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA; Department of Pathology, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Gunther Marsche
- Otto Loewi Research Center, Division of Pharmacology, Medical University of Graz, Austria
| | - Wanda F Reynolds
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.
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