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Kraus MJ, Smits JM, Meyer AL, Strelniece A, van Kins A, Boeken U, Reinecke A, Provaznik Z, Van Caenegem O, Ancion A, Berchtold-Herz M, Van Cleemput JJA, Haverich A, Laufer G, Gummert J, Karck M, Warnecke G, Raake PW, Frey N, Kreusser MM. Outcomes in patients with cardiac amyloidosis undergoing heart transplantation: the eurotransplant experience. J Heart Lung Transplant 2023; 42:778-785. [PMID: 36710093 DOI: 10.1016/j.healun.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND When advanced heart failure occurs in cardiac amyloidosis, prognosis is poor. In this setting heart transplantation (HTX) is a treatment option for selected patients. We here present the results of post-transplantation outcomes in cardiac amyloidosis within the Eurotransplant area, investigating possible predictors of survival. METHODS Of 115 patients undergoing HTX due to cardiac amyloidosis in the Eurotransplant region between November 1987 and May 2020, detailed assessment prior to transplantation was available in 85 patients. The present study was conducted in a retrospective approach. Primary endpoint was mortality after HTX. Baseline variables were entered in a Cox proportional hazards model with the primary endpoint as a dependent variable. RESULTS Median overall survival following HTX was 6.3 years in the overall collective and the subgroup. Univariate Cox proportional hazards model revealed a significant relationship between overall survival and the transplantation period (2008 to 2020 vs 1987 to 2007; median survival 9.7 years vs 1.8 years, hazard ratio 0.45, p = 0.01). Further predictors were albumin concentration (hazard ratio 0.92, p < 0.001), and systolic blood pressure (hazard ratio 0.96, p < 0.001). The transplant period as well as albumin concentration remained significant independent predictors in the AL sub cohort in a multivariate Cox proportional hazards model. CONCLUSIONS HTX is a viable treatment option for patients at an advanced stage of cardiac amyloidosis as overall survival after transplantation has improved in the modern age. Patients at a very advanced stage of the disease, indicated by low serum albumin and blood pressure, show worse outcomes following HTX. Optimal timing and careful patient selection may therefore be particularly important to further improve post-HTX survival in amyloidosis patients.
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Affiliation(s)
- Martin J Kraus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany.
| | | | - Anna L Meyer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | | | | | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
| | - Alexander Reinecke
- Department of Cardiology, Angiology and Intensive Care, University of Kiel, Kiel, Germany
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Oliver Van Caenegem
- Cardiovascular Department, Intensive Care Unit, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (deceased)
| | - Arnaud Ancion
- Cardiology, Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany; Department of Medicine, University Heart Center Freiburg, Freiburg, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenther Laufer
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Jan Gummert
- Heart and Diabetes Center Nord-Rhein-Westfalen, Ruhr University Bochum, Bochum, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany; Department of Cardiology, University Hospital of Augsburg, Augsburg Germany
| | - Norbert Frey
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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Müller J, Weinert L, Svensson L, Rivinius R, Kreusser MM, Heinze O. Mobile Access to Medical Records in Heart Transplantation Aftercare: Mixed-Methods Study Assessing Usability, Feasibility and Effects of a Mobile Application. Life (Basel) 2022; 12:1204. [PMID: 36013383 PMCID: PMC9410472 DOI: 10.3390/life12081204] [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: 06/30/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patient access to medical records can improve quality of care. The phellow application (app) was developed to provide patients access to selected content of their medical record. It was tested at a heart transplantation (HTx) outpatient clinic. The aims of this study were (1) to assess usability of phellow, (2) to determine feasibility of implementation in routine care, and (3) to study the effects app use had on patients' self-management. METHODS Usability was measured quantitatively through the System Usability Scale (SUS). Furthermore, usability, feasibility, and effects on self-management were qualitatively assessed through interviews with users, non-users, and health care providers. RESULTS The SUS rating (n = 31) was 79.9, indicating good usability. Twenty-three interviews were conducted. Although appreciation and willingness-to-use were high, usability problems such as incompleteness of record, technical issues, and complex registration procedures were reported. Improved technical support infrastructure, clearly defined responsibilities, and app-specific trainings were suggested for further implementation. Patients described positive effects on their self-management. CONCLUSIONS To be feasible for implementation in routine care, usability problems should be addressed. Feedback on the effect of app use was encouraging. Accompanying research is crucial to monitor usability improvements and to further assess effects of app use on patients.
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Affiliation(s)
- Julia Müller
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Lina Weinert
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Section for Translational Health Economics, Department for Conservative Dentistry, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Laura Svensson
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Michael M. Kreusser
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Oliver Heinze
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Sommer W, Avsar M, Aburahma K, Salman J, Kaufeld KT, Rojas SV, Meyer AL, Chichelnitskiy E, Süsal C, Kreusser MM, Verboom M, Hallensleben M, Bara C, Blasczyk R, Falk C, Karck M, Haverich A, Ius F, Warnecke G. Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol. Am J Transplant 2022; 22:2064-2076. [PMID: 35426974 DOI: 10.1111/ajt.17060] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 01/25/2023]
Abstract
Heart transplantation across preformed donor-specific HLA-antibody barriers is associated with impaired short- and long-term survival. Therefore, in recipients with preformed anti-HLA antibodies, waiting for crossmatch-negative donors is standard practice. As an alternative strategy, recipients with preformed anti-HLA donor specific antibodies have been managed at our institutions with a perioperative desensitization regimen. A retrospective analysis was performed comparing heart transplant recipients with preformed donor-specific HLA-antibodies to recipients without donor-specific antibodies. Recipients with a positive virtual crossmatch received a perioperative desensitization protocol including tocilizumab intraoperatively, plasma exchange and rituximab followed by a six-month course of IgGAM. Among the 117 heart-transplanted patients, 19 (16%) patients underwent perioperative desensitization, and the remaining 98 (84%) patients did not. Cold ischemic time, posttransplant extracorporeal life support for primary graft dysfunction, and intensive care unit stay time did not differ between groups. At 1-year follow-up, freedom from pulsed steroid therapy for presumed rejection and biopsy-confirmed acute cellular or humoral rejection did not differ between groups. One-year survival amounted to 94.7% in the treated patients and 81.4% in the control group. Therefore, heart transplantation in sensitized recipients undergoing a perioperative desensitization appears safe with comparable postoperative outcomes as patients with a negative crossmatch.
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Affiliation(s)
- Wiebke Sommer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Khalil Aburahma
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Klaus Tim Kaufeld
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Anna L Meyer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Evgeny Chichelnitskiy
- Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany
| | - Caner Süsal
- Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | | | - Murielle Verboom
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Michael Hallensleben
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Christoph Bara
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Christine Falk
- Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Vascular and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
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Geis NA, Göbbel A, Kreusser MM, Täger T, Katus HA, Frey N, Schlegel P, Raake PW. Impact of Percutaneous Mitral Valve Repair Using the MitraClipTM System on Ventricular Arrhythmias and ICD Therapies. Life (Basel) 2022; 12:life12030344. [PMID: 35330095 PMCID: PMC8950873 DOI: 10.3390/life12030344] [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: 02/10/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022] Open
Abstract
Transcatheter edge-to-edge repair (TEER) using the MitraClip™ device has been established as a suitable alternative to mitral valve surgery in patients with severe mitral regurgitation (MR) and high or prohibitive surgical risk. Only limited information regarding the impact of TEER on ventricular arrhythmias (VA) has been reported. The aim of the present study was to assess the impact of TEER using the MitraClipTM device on the burden of VA and ICD (Implantable Cardioverter Defibrillator) therapies. Among 600 MitraClipTM implantations performed in our clinic between September 2009 and October 2018, we identified 86 patients with successful TEER and an active implantable cardiac device (pacemaker, ICD, CRT-P/D (Cardiac Resynchronization Therapy-Pacemaker/Defibrillator)) eligible for retrospective VA analyses. These patients presented with mainly functional MR (81.4%) and severely reduced left ventricular ejection fraction (mean LVEF 22.1% ± 10.3%). The observation period comprised 456 ± 313 days before and 424 ± 287 days after TEER. The burden of ventricular arrhythmias (sustained ventricular tachycardia (sVT) and ventricular fibrillation (VF)) was significantly reduced after TEER (0.85 ± 3.47 vs. 0.43 ± 2.03 events per patient per month, p = 0.01). Furthermore, the rate of ICD therapies (anti-tachycardia pacing (ATP) and ICD shock) decreased significantly after MitraClipTM implantation (1.0 ± 3.87 vs. 0.32 ± 1.41, p = 0.014). However, reduction of VA burden did not result in improved two-year survival in this patient cohort with severely reduced LVEF. Mitral valve TEER using the MitraClip™ device was associated with a significant reduction of ventricular arrhythmias and ICD therapies.
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Affiliation(s)
- Nicolas A. Geis
- Correspondence: ; Tel.: +49-6221-56-8676; Fax: +49-6221-56-5515
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Volz MJ, Aurich M, Konstandin M, Katus HA, Frey N, Kreusser MM, Raake PW. Abfall von Sauerstoffsättigung und Blutdruck sowie Anstieg des zentralen Venendrucks im Rahmen eines Mitralklappenclippings bei einer 81-Jährigen. Internist (Berl) 2022; 63:448-452. [PMID: 35129621 PMCID: PMC8956558 DOI: 10.1007/s00108-021-01241-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Atriumseptumdefekte (ASD) im Rahmen eines endovaskulären Mitralklappenclippings sind potenziell hämodynamisch relevante Komplikationen. Ein sofortiger Verschluss mittels Okkluder kann eine sichere und effektive Therapie darstellen. Fallzusammenfassung Eine 81-jährige Patientin mit schwerer Dyspnoe bei vorbekannter hochgradiger Mitralklappeninsuffizienz wurde zum elektiven Mitralklappenclipping vorgestellt. Die Clipimplantation verlief komplikationslos. Nach Entfernung der transseptalen Schleuse kam es zu einem plötzlichen Abfall der Sauerstoffsättigung und des Blutdrucks sowie zu einem sofortigen Anstieg des zentralen Venendrucks. Es zeigte sich ein iatrogener Links-rechts-Shunt auf Vorhofebene mit relevantem Shuntvolumen. Daraufhin erfolgte der sofortige Verschluss mittels Vorhofseptumokkluder, was zu einer unmittelbaren Besserung der Kreislaufparameter und der Sauerstoffsättigung führte. Schlussfolgerung Ein Anstieg des zentralen Venendrucks, ein Blutdruckabfall oder Sättigungsabfall nach Rückzug der transseptalen steuerbaren Schleuse im Rahmen des Mitralklappenclippings sollte bezüglich eines möglichen ASD abgeklärt werden.
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Affiliation(s)
- Martin J Volz
- Klinik für Innere Medizin III, Abteilung für Kardiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - Matthias Aurich
- Klinik für Innere Medizin III, Abteilung für Kardiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - Mathias Konstandin
- Klinik für Innere Medizin III, Abteilung für Kardiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
- DZHK-Standort Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
| | - Hugo A Katus
- DZHK-Standort Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
| | - Norbert Frey
- Klinik für Innere Medizin III, Abteilung für Kardiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
- DZHK-Standort Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
| | | | - Philip W Raake
- DZHK-Standort Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
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6
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Heil KM, Helmschrott M, Darche FF, Bruckner T, Ehlermann P, Kreusser MM, Doesch AO, Sommer W, Warnecke G, Frey N, Rivinius R. Risk Factors, Treatment and Prognosis of Patients with Lung Cancer after Heart Transplantation. Life (Basel) 2021; 11:life11121344. [PMID: 34947875 PMCID: PMC8707242 DOI: 10.3390/life11121344] [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: 11/01/2021] [Revised: 11/21/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
Long-term survival after heart transplantation (HTX) is impacted by adverse effects of immunosuppressive pharmacotherapy, and post-transplant lung cancer is a common occurrence. This study aimed to examine the risk factors, treatment, and prognosis of patients with post-transplant lung cancer. We included 625 adult patients who received HTX at Heidelberg Heart Center between 1989 and 2018. Patients were stratified by diagnosis and staging of lung cancer after HTX. Analysis comprised donor and recipient characteristics, medications including immunosuppressive drugs, and survival after diagnosis of lung cancer. A total of 41 patients (6.6%) were diagnosed with lung cancer after HTX, 13 patients received curative care and 28 patients had palliative care. Mean time from HTX until diagnosis of lung cancer was 8.6 ± 4.0 years and 1.8 ± 2.7 years from diagnosis of lung cancer until last follow-up. Twenty-four patients (58.5%) were switched to an mTOR-inhibitor after diagnosis of lung cancer. Multivariate analysis showed recipient age (HR: 1.05; CI: 1.01-1.10; p = 0.02), COPD (HR: 3.72; CI: 1.88-7.37; p < 0.01), and history of smoking (HR: 20.39; CI: 2.73-152.13; p < 0.01) as risk factors for post-transplant lung cancer. Patients in stages I and II had a significantly better 1-year (100.0% versus 3.6%), 2-year (69.2% versus 0.0%), and 5-year survival (53.8% versus 0.0%) than patients in stages III and IV (p < 0.01). Given the poor prognosis of late-stage post-transplant lung cancer, routine reassessment of current smoking status, providing smoking cessation support, and intensified lung cancer screening in high-risk HTX recipients are advisable.
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Affiliation(s)
- Karsten M. Heil
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
| | - Fabrice F. Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Michael M. Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Andreas O. Doesch
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
- Department of Pneumology and Oncology, Asklepios Hospital, 36433 Bad Salzungen, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (W.S.); (G.W.)
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (W.S.); (G.W.)
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.H.); (M.H.); (F.F.D.); (P.E.); (M.M.K.); (A.O.D.); (N.F.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-8676; Fax: +49-6221-56-5515
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7
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Kreusser MM, Weber A, Geis NA, Grossekettler L, Volz MJ, Hamed S, Katus HA, Pleger ST, Frey N, Raake PW. Re-do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure. ESC Heart Fail 2021; 8:4617-4625. [PMID: 34498422 PMCID: PMC8712900 DOI: 10.1002/ehf2.13564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/08/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Aim Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for severe mitral regurgitation (MR) in advanced stages of heart failure (HF). However, progressive left ventricular dilation in these patients may lead to recurrent MR after PMVR and consequent re‐do MitraClip implantation. Here, we describe the characteristics and outcomes of this clinical scenario. Methods and results Patients with systolic HF and functional MR undergoing a re‐do MitraClip procedure were retrospectively analysed. Inclusion criteria were age ≥18 years, technical, device and procedural success at first MitraClip procedure, functional MR and systolic HF with an ejection fraction (EF) of <45%. Seventeen out of 684 patients undergoing PMVR with the MitraClip device at our institution between September 2009 and July 2019 were included. All patients displayed advanced HF with an EF of 20% (±9.9) and highly elevated N‐terminal pro‐brain natriuretic peptide. Technical success of the re‐do MitraClip procedure was 100%, whereas procedural and device success were only achieved in 11 patients (65%). Unsuccessful re‐do procedures were related to lower EF and implantation of more than one clip at initial procedure. However, despite reduction in MR grade and no occurrence of significant mitral stenosis after the procedure, the mortality during 12 months follow‐up remained high (8 of 17; 47%). Conclusions In a cohort of patients with advanced HF undergoing PMVR, re‐do MitraClip procedure was feasible, but procedural success was unsatisfactory and morbidity and mortality remained high, possibly reflecting the advanced stage of HF in these patients.
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Affiliation(s)
- Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Andreas Weber
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Martin J Volz
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Sonja Hamed
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
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8
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Darche FF, Helmschrott M, Rahm AK, Thomas D, Schweizer PA, Bruckner T, Ehlermann P, Kreusser MM, Warnecke G, Frey N, Rivinius R. Atrial fibrillation before heart transplantation is a risk factor for post-transplant atrial fibrillation and mortality. ESC Heart Fail 2021; 8:4265-4277. [PMID: 34453484 PMCID: PMC8497346 DOI: 10.1002/ehf2.13552] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Atrial fibrillation (AF) after heart transplantation (HTX) is associated with worse clinical outcomes. The current study aimed to analyse the association between AF before HTX and AF within 30 days after HTX. METHODS AND RESULTS This study included 639 adults who received HTX at Heidelberg Heart Center. Patients were subdivided into four groups depending on the status of AF before and after HTX. Analyses comprised recipient and donor data, medication, echocardiographic features, permanent pacemaker implantation, stroke, and mortality after HTX. Three hundred thirty-two patients (52.0%) had neither AF before nor after HTX, 15 patients (2.3%) had no AF before HTX but showed AF after HTX, 219 patients (34.3%) showed AF before HTX but had no AF after HTX, and 73 patients (11.4%) had AF before and after HTX. Patients with AF before and after HTX had a higher 1 year post-transplant mortality (39.7%) than patients without AF before or after HTX (18.1%, P < 0.01). Secondary outcomes showed a higher percentage of enlarged atria, ventricular dysfunction, mitral regurgitation, 1-year stroke, and 1-year permanent pacemaker implantation in patients with AF before and after HTX. Multivariate analysis revealed a six-fold elevated risk for post-transplant AF in patients with AF before HTX (hazard ratio: 6.59, confidence interval: 3.72-11.65; P < 0.01). Further risk factors for post-transplant AF were higher donor age and prolonged ischaemic time, whereas total orthotopic HTX was associated with a two-fold lower risk for post-transplant AF. CONCLUSIONS Atrial fibrillation before HTX is a risk factor for post-transplant AF, permanent pacemaker implantation, and mortality after HTX.
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Affiliation(s)
- Fabrice F Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Ann-Kathrin Rahm
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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9
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Schlegel P, Crespo López P, Kreusser MM, Katus HA, Frey N, Geis NA, Raake PWJ. PASCAL-based mitral valve repair in an all-comer population: acute and mid-term clinical results. ESC Heart Fail 2021; 8:3530-3538. [PMID: 34448541 PMCID: PMC8497336 DOI: 10.1002/ehf2.13569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS We investigated short and mid-term safety and efficacy of the PASCAL system for percutaneous mitral valve repair (PMVr) in severe mitral regurgitation (MR) in an all-comer population. METHODS AND RESULTS In the first consecutive 41 patients undergoing PMVr using the PASCAL system in our centre, procedural success and safety were assessed. Efficacy in improving MR and functional class were evaluated. Median patient age was 74 years, 58.5% were male patients, and median European System for Cardiac Operative Risk Evaluation Score II was 5.1%. All patients suffered from severe MR with 59% functional MR, 29% degenerative MR, and 12% of mixed aetiology MR. The technical success rate was 90%, limited by four cases where PASCAL implantation was aborted due to a prohibitive mitral gradient. On average, 1.16 PASCAL devices per patient were implanted. All patients successfully implanted with a PASCAL device were discharged with MR grade ≤ 2 and 79% with MR grade ≤ 1. Mean follow-up was 8.7 ± 4.9 months. Ninety-seven per cent of patients remained at MR ≤ 2 at follow-up, which translated into a significantly improved New York Heart Association functional class as well as a significant reduction of systolic pulmonary artery pressure and brain natriuretic peptide levels. The procedure-related rate for major adverse events was 3%. Neither early nor late single-leaflet detachment was found. In one patient, air embolism occurred, resulting in modification of the PASCAL instructions for use. CONCLUSIONS Percutaneous mitral valve repair using PASCAL in a real-world, all-comer population was feasible and safe, resulting in a significant mid-term reduction of MR with persistent clinical improvement.
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Affiliation(s)
- Philipp Schlegel
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Patricia Crespo López
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Nicolas A Geis
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
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10
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Rahm AK, Helmschrott M, Darche FF, Thomas D, Bruckner T, Ehlermann P, Kreusser MM, Warnecke G, Frey N, Rivinius R. Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival. ESC Heart Fail 2021; 8:3737-3747. [PMID: 34213089 PMCID: PMC8497214 DOI: 10.1002/ehf2.13494] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Right bundle branch block (RBBB) after heart transplantation (HTX) is a common finding, but its impact on post‐transplant survival remains uncertain. This study investigated the post‐transplant outcomes of patients with complete RBBB (cRBBB) ≤ 30 days after HTX. Methods This registry study analysed 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis of cRBBB ≤ 30 days after HTX. Analysis included recipient and donor data, medication, echocardiographic features, graft rejections, atrial fibrillation, heart rates, permanent pacemaker implantation and mortality after HTX including causes of death. Results One hundred thirty‐nine patients showed cRBBB ≤ 30 days after HTX (21.8%), 20 patients with pre‐existing cRBBB in the donor heart (3.2%) and 119 patients with newly acquired cRBBB (18.6%). Patients with newly acquired cRBBB had a worse 1‐year post‐transplant survival (36.1%, P < 0.01) compared with patients with pre‐existing cRBBB (85.0%) or without cRBBB (86.4%), along with a higher percentage of death due to graft failure (P < 0.01). Multivariate analysis indicated cRBBB ≤ 30 days after HTX as significant risk factor for 1‐year mortality after HTX (HR: 2.20; 95% CI: 1.68–2.87; P < 0.01). Secondary outcomes showed a higher rate of an enlarged right atrium (P = 0.01), enlarged right ventricle (P < 0.01), reduced right ventricular function (P < 0.01), 30‐day atrial fibrillation (P < 0.01) and 1‐year permanent pacemaker implantation (P = 0.02) in patients with cRBBB after HTX. Conclusions Newly acquired cRBBB early after HTX is associated with increased post‐transplant mortality.
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Affiliation(s)
- Ann-Kathrin Rahm
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Fabrice F Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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11
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Volz MJ, Pleger ST, Weber A, Geis NA, Hamed S, Mereles D, Hegenbart U, Katus HA, Frey N, Raake PW, Kreusser MM. Initial experience with percutaneous mitral valve repair in patients with cardiac amyloidosis. Eur J Clin Invest 2021; 51:e13473. [PMID: 33326601 DOI: 10.1111/eci.13473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) is a therapeutic option for severe mitral regurgitation (MR) in patients with heart failure due to differential aetiologies. However, only little is known about the safety and efficacy of this procedure in patients with amyloid cardiomyopathy. METHODS Five patients with cardiac amyloidosis and moderate to severe or severe MR undergoing PMVR were analysed retrospectively and compared to seven patients with cardiac amyloidosis and severe MR without intervention. Clinical and functional data, renal function and cardiac biomarkers as well as established risk scores for cardiac amyloidosis were assessed. Primary endpoint was the reduction in MR one year after PMVR. Secondary endpoints were safety, overall mortality after 12 months compared with the control group, as well as changes in clinical and functional parameters. RESULTS Amyloidosis risk assessment documented amyloid cardiomyopathy at an advanced stage in all patients. Procedural, technical and device success of PMVR were all 100% and residual MR remained mild to moderate at 12 months follow-up (P = .038 vs before PMVR). Differences in survival compared with the control (no PMVR) group pointed to a possible survival benefit in the PMVR group (P = .02). CONCLUSION PMVR is a feasible and safe procedure in patients with cardiac amyloidosis and might carry a possible survival benefit in this patient group.
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Affiliation(s)
- Martin J Volz
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Sven T Pleger
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Andreas Weber
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Nicolas A Geis
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Sonja Hamed
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Derliz Mereles
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- Division of Hematology and Oncology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Norbert Frey
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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12
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Kremer J, Farag M, Brcic A, Zubarevich A, Schamroth J, Kreusser MM, Karck M, Ruhparwar A, Schmack B. Temporary right ventricular circulatory support following right ventricular infarction: results of a groin-free approach. ESC Heart Fail 2020; 7:2853-2861. [PMID: 33121217 PMCID: PMC7524043 DOI: 10.1002/ehf2.12888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/07/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 12/23/2022] Open
Abstract
Aims Acute right heart failure (RHF) is a severe complication of right ventricular infarction. The management of acute RHF poses a number of challenges, such as providing haemodynamic support. Temporary circulatory support (TCS) may be required upon failing medical therapy. The ProtekDuo® dual lumen cannula provides a minimally invasive option for (TCS) through a groin‐free internal jugular vein approach. We present the largest patient series to date using the ProtekDuo® cannula as temporary right ventricular assist device (t‐RVAD) in RHF after acute myocardial infarction (MI). Methods and results From July 2016 to November 2019, 10 patients underwent t‐RVAD implantation for RHF following acute MI. Transthoracic and transoesophageal echocardiography were performed in all patients to assess cardiac function, with a particular focus on RV function. Cumulative 30‐day survival was 60%. Mean TAPSE was 6.4 ± 3.1 mm, mean fractional area change was 12.1 ± 4.2%, and mean right ventricular end diastolic area was 19.8 ± 2.7 cm2. Mean implantation time was 32.8 ± 8.3 min. Mean interval after first cardiac intervention was 4.6 ± 5.8 days. Mean t‐RVAD time was 10.0 ± 7.4 days with a significant reduction in central venous pressure 19.3 ± 2.7 vs. 8.2 ± 2.6 mmHg, P < 0.001 and a significant increase in central venous saturation 52.8 ± 15.6 vs. 80.0 ± 6.0%, P < 0.001. Mean intensive care unit stay was 18.6 ± 12.2 days. Four patients were weaned from TCS. Two patients were bridged to a long‐term paracorporeal RVAD. There were no t‐RVAD associated complications. Causes of death (n = 4) were multiorgan failure, electromechanical dissociation, and haemorrhagic stroke. Mean follow‐up time was 96.0 ± 107.6 days. No independent predictors of mortality were identified in univariate analysis. Conclusions We show that groin‐free, percutaneous implantation of the ProtekDuo® cannula is a feasible and safe tool for TCS in acute RHF post‐MI. This approach provides the advantages of percutaneous implantation including complete mobilization and non‐surgical bedside explantation, as well as the option for adding an oxygenator to the t‐RVAD circuit.
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Affiliation(s)
- Jamila Kremer
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Mina Farag
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Andreas Brcic
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Anesthesiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alina Zubarevich
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Joel Schamroth
- Department of Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Michael M Kreusser
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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13
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Kreusser MM, Hamed S, Weber A, Schmack B, Volz MJ, Geis NA, Grossekettler L, Pleger ST, Ruhparwar A, Katus HA, Raake PW. MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure. ESC Heart Fail 2020; 7:3891-3900. [PMID: 33107214 PMCID: PMC7754960 DOI: 10.1002/ehf2.12982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/29/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Aims Mitral valve regurgitation (MR) is common in patients with advanced heart failure (HF). Percutaneous mitral valve repair (PMVR) via MitraClip (MC) has emerged as a feasible treatment strategy for these high‐risk patients. However, as HF often further progresses, there is a frequent need for left ventricular assist device (LVAD) implantation in these patients. We aimed to investigate whether prior MC implantation affects the subsequent LVAD implantation and outcome. Methods and results Thirty‐seven patients with advanced HF and significant MR who underwent LVAD implantation were retrospectively analysed. Follow‐up data were collected at 1 year after LVAD implantation. Primary endpoint was all‐cause mortality. Secondary endpoint included peri‐operative parameters and clinical development depicted as New York Heart Association (NYHA) class and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Seventeen patients initially received a MC device (MC group), resulting in a significant reduction in MR grade. After MC, NYHA class and INTERMACS level further worsened, leading to subsequent LVAD implantation after a median time of 475 days in the MC group. At LVAD implantation, overall characteristics were comparable with those of the patients undergoing LVAD implantation without prior MC placement (no‐MC group). Procedural data revealed a higher incidence of right ventricular (RV) failure needing mechanical RV assistance and a longer need for nitric oxide ventilation in the MC group after LVAD implantation. One‐year survival was slightly better in the no‐MC group compared with the MC group [41% (n = 7/17) vs. 65% (n = 13/20); P = 0.15], albeit event‐free survival was comparable between both groups, MC and no‐MC. Conclusions LVAD implantation after MC is feasible and safe. However, in patients with advanced HF and severe MR, PMVR may only delay a needed LVAD implantation and thereby lead to poorer peri‐operative RV function and impaired outcome. Arguably, these patients might benefit from the timely management of advanced HF by the means of early LVAD implantation or heart transplantation.
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Affiliation(s)
- Michael M Kreusser
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sonja Hamed
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Andreas Weber
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Martin J Volz
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Nicolas A Geis
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Leonie Grossekettler
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Sven T Pleger
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.,Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Hugo A Katus
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
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14
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Rivinius R, Kaya Z, Schramm R, Boeken U, Provaznik Z, Heim C, Knosalla C, Schoenrath F, Rieth A, Berchtold-Herz M, Barten MJ, Rauschning D, Mücke VT, Heyl S, Pistulli R, Grinninger C, Hagl C, Gummert JF, Warnecke G, Schulze PC, Katus HA, Kreusser MM, Raake PW. COVID-19 among heart transplant recipients in Germany: a multicenter survey. Clin Res Cardiol 2020; 109:1531-1539. [PMID: 32783099 PMCID: PMC7418884 DOI: 10.1007/s00392-020-01722-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023]
Abstract
Aims Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. Methods and results A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). Conclusion Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.
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Affiliation(s)
- Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Ziya Kaya
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - René Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Zdenek Provaznik
- Department of Cardiovascular Surgery, Regensburg University Hospital, Regensburg, Germany
| | - Christian Heim
- Department of Cardiovascular Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff Hospital, Bad Nauheim, Germany
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
| | - Dominic Rauschning
- Department of Internal Medicine, Bundeswehr Central Hospital, Koblenz, Germany
| | - Victoria T Mücke
- Department of Internal Medicine I, Frankfurt University Hospital, Frankfurt, Germany
| | - Stephan Heyl
- Department of Internal Medicine III, Frankfurt University Hospital, Frankfurt, Germany
| | - Rudin Pistulli
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Münster University Hospital, Münster, Germany
| | - Carola Grinninger
- Department of Cardiac Surgery, Munich University Hospital, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Munich University Hospital, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Gregor Warnecke
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - P Christian Schulze
- Department of Cardiology, Angiology and Pneumology, Jena University Hospital, Jena, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
- German Center for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany.
| | - Philip W Raake
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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15
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Reil JC, Reil GH, Kovács Á, Sequeira V, Waddingham MT, Lodi M, Herwig M, Ghaderi S, Kreusser MM, Papp Z, Voigt N, Dobrev D, Meyhöfer S, Langer HF, Maier LS, Linz D, Mügge A, Hohl M, Steendijk P, Hamdani N. CaMKII activity contributes to homeometric autoregulation of the heart: A novel mechanism for the Anrep effect. J Physiol 2020; 598:3129-3153. [PMID: 32394454 DOI: 10.1113/jp279607] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/04/2020] [Indexed: 01/14/2023] Open
Abstract
KEY POINTS The Anrep effect represents the alteration of left ventricular (LV) contractility to acutely enhanced afterload in a few seconds, thereby preserving stroke volume (SV) at constant preload. As a result of the missing preload stretch in our model, the Anrep effect differs from the slow force response and has a different mechanism. The Anrep effect demonstrated two different phases. First, the sudden increased afterload was momentary equilibrated by the enhanced LV contractility as a result of higher power strokes of strongly-bound myosin cross-bridges. Second, the slightly delayed recovery of SV is perhaps dependent on Ca2+ /calmodulin-dependent protein kinase II activation caused by oxidation and myofilament phosphorylation (cardiac myosin-binding protein-C, myosin light chain 2), maximizing the recruitment of available strongly-bound myosin cross-bridges. Short-lived oxidative stress might present a new facet of subcellular signalling with respect to cardiovascular regulation. Relevance for human physiology was demonstrated by echocardiography disclosing the Anrep effect in humans during handgrip exercise. ABSTRACT The present study investigated whether oxidative stress and Ca2+ /calmodulin-dependent protein kinase II (CaMKII) activity are involved in triggering the Anrep effect. LV pressure-volume (PV) analyses of isolated, preload controlled working hearts were performed at two afterload levels (60 and 100 mmHg) in C57BL/6N wild-type (WT) and CaMKII-double knockout mice (DKOCaMKII ). In snap-frozen WT hearts, force-pCa relationship, H2 O2 generation, CaMKII oxidation and phosphorylation of myofilament and Ca2+ handling proteins were assessed. Acutely raised afterload showed significantly increased wall stress, H2 O2 generation and LV contractility in the PV diagram with an initial decrease and recovery of stroke volume, whereas end-diastolic pressure and volume, as well as heart rate, remained constant. Afterload induced increase in LV contractility was blunted in DKOCaMKII -hearts. Force development of single WT cardiomyocytes was greater with elevated afterload at submaximal Ca2+ concentration and associated with increases in CaMKII oxidation and phosphorylation of cardiac-myosin binding protein-C, myosin light chain and Ca2+ handling proteins. CaMKII activity is involved in the regulation of the Anrep effect and associates with stimulation of oxidative stress, presumably starting a cascade of CaMKII oxidation with downstream phosphorylation of myofilament and Ca2+ handling proteins. These mechanisms improve LV inotropy and preserve stroke volume within few seconds.
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Affiliation(s)
- Jan-Christian Reil
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gert-Hinrich Reil
- Klinik für Kardiologie, Klinikum Oldenburg, Innere Medizin I, Oldenburg, Germany
| | - Árpád Kovács
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Vasco Sequeira
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Germany
| | - Mark T Waddingham
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maria Lodi
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Melissa Herwig
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Shahrooz Ghaderi
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Michael M Kreusser
- Departments of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Niels Voigt
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.,Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Svenja Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany and German Center for Diabetes Research, Neuherberg, Germany
| | - Harald F Langer
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lars S Maier
- Klinik und Poliklinik für innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Dominik Linz
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Andreas Mügge
- Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III (Kardiologie, Angiologie, Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Paul Steendijk
- Departments of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nazha Hamdani
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany.,Department of Cardiology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany.,Molecular and Experimental Cardiology, Ruhr Universität Bochum, Bochum, Germany.,Department Clinical Pharmacology, Ruhr University of Bochum, Bochum, Germany
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16
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Sedaghat-Hamedani F, Kayvanpour E, Hamed S, Frankenstein L, Riffel J, Gi WT, Amr A, Shirvani Samani O, Haas J, Miersch T, Herpel E, Kreusser MM, Ehlermann P, Katus HA, Meder B. The chameleon of cardiology: cardiac sarcoidosis before and after heart transplantation. ESC Heart Fail 2019; 7:692-696. [PMID: 31802644 PMCID: PMC7160489 DOI: 10.1002/ehf2.12581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/19/2019] [Revised: 10/01/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022] Open
Abstract
Cardiac sarcoidosis is a chronic inflammatory disease with a large spectrum of symptoms that can mimic diseases such as dilated, hypertrophic, or arrhythmogenic cardiomyopathies. It can be asymptomatic but can also present with ventricular arrhythmias, conduction disease, and heart failure (HF) or even sudden cardiac death (SCD). We present here the case of a patient transplanted due to end‐stage arrhythmogenic right ventricular cardiomyopathy (ARVC), fulfilling the task force criteria. A few years after successful heart transplantation (HTX), the patient developed similar symptoms and morphofunctional changes of the heart, which led to critical re‐evaluation of his primary diagnosis.
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Affiliation(s)
- Farbod Sedaghat-Hamedani
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Elham Kayvanpour
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Sonja Hamed
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Weng-Tein Gi
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Ali Amr
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Omid Shirvani Samani
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Jan Haas
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Tobias Miersch
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Esther Herpel
- Tissue Bank of the National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Hugo A Katus
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Benjamin Meder
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany.,Department of Genetics, Stanford University, Stanford, CA, 94305, USA
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17
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Kreusser MM, Volz MJ, Knop B, Ehlermann P, Schmack B, Ruhparwar A, Hegenbart U, Schönland SO, Katus HA, Raake PW. A novel risk score to predict survival in advanced heart failure due to cardiac amyloidosis. Clin Res Cardiol 2019; 109:700-713. [PMID: 31630214 DOI: 10.1007/s00392-019-01559-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiac amyloidosis, caused by deposition of immunoglobulin light chains (AL) or transthyretin (ATTR), carries a poor prognosis. Established risk scores for amyloidosis may not predict outcomes in those patients who develop advanced heart failure and who are potential candidates for heart transplantation. Here, we aimed to identify predictive parameters for patients with severe heart failure due to amyloidosis. METHODS Out of > 1000 patients with cardiac amyloidosis (AL or ATTR) admitted to our centre between September 1998 and January 2016, a cohort of 120 patients with a complete cardiac assessment at diagnosis, including right heart catheterization, echocardiography and biomarkers, was analysed retrospectively in this study. Primary endpoint was all-cause mortality. We performed univariate and multivariate Cox regression analysis, generated risk scores to predict outcomes in AL and ATTR amyloidosis and compared those to established risk models for amyloidosis. RESULTS In the Cox multivariate model, high-sensitivity troponin T (hsTnT; hazard ratio (HR) 1.003; confidence interval (CI) 1.001-1.005; p = 0.009) and mean pulmonary artery pressure (HR 1.061; CI 1.024-1.100; p = 0.001) were found to significantly and independently predict outcomes for AL amyloidosis, whereas QRS duration (HR 1.021; CI 1.004-1.039; p = 0.013), hsTnT (HR 1.021; CI 1.006-1.036; p = 0.006) and N-terminal pro-brain natriuretic peptide (HR 1.0003; CI 1.0001-1.0004; p = 0.002) were the best predictors for ATTR amyloidosis. A simple risk score ("HeiRisk") including these parameters for AL and ATTR allowed a more precise risk stratification in our patient population compared to established risk models. CONCLUSIONS Risk stratification for cardiac amyloidosis with the newly developed "HeiRisk" score may be superior to other staging systems for patients with advanced heart failure due to amyloid cardiomyopathy.
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Affiliation(s)
- Michael M Kreusser
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany.
| | - Martin J Volz
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Benjamin Knop
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philipp Ehlermann
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- Division of Hematology and Oncology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Stefan O Schönland
- Division of Hematology and Oncology, Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Division of Cardiology, Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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18
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Ruhparwar A, Zubarevich A, Osswald A, Raake PW, Kreusser MM, Grossekettler L, Karck M, Schmack B. ECPELLA 2.0-Minimally invasive biventricular groin-free full mechanical circulatory support with Impella 5.0/5.5 pump and ProtekDuo cannula as a bridge-to-bridge concept: A first-in-man method description. J Card Surg 2019; 35:195-199. [PMID: 31609509 DOI: 10.1111/jocs.14283] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) from biventricular heart failure that requires acute mechanical circulatory support (MCS) is associated with high mortality. Different MCS methods and techniques have emerged as a standard of care in CS. Nevertheless, the routine MCS approach carries multiple limitations such as limb ischemia, missing of left ventricular unloading and immobilization. We describe a method to establish a groin-free full support MCS in patients with CS without the need for thoracotomy. This is the first report of the ECPELLA 2.0 concept, a peripheral groin-free biventricular MCS in patients with acute CS. METHODS AND RESULTS We discuss two patients in acute CS (INTERMACS I) treated with two peripheral MCS devices (Impella 5.0 or 5.5 surgically via an axillary artery and ProtekDuo cannula percutaneously via a right internal jugular vein) as a bridge before the implantation of a durable left ventricular assist device (LVAD). Biventricular assist device (BIVAD)-support duration was 9 and 15 days and both of the patients were successfully bridged to a durable LVAD. As our BIVAD-concept is groin-free, the patients started full mobilization as early as they were weaned from the respirator 2 days after the BIVAD-implantation. ECPELLA 2.0 provides a high cardiac output, right and left ventricular unloading with end-organ recovery and a possibility of administration of a membrane oxygenator. There were no device-related complications. CONCLUSION The ECPELLA 2.0 biventricular support concept for patients suffering from an acute CS. Allows for rapid extubation, mobilization, and physical exercise while on full support. Additional application of a membrane oxygenator is easily feasible if required.
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Affiliation(s)
- Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Duisburg/Essen, Essen, Germany
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Duisburg/Essen, Essen, Germany
| | - Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Duisburg/Essen, Essen, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
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19
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Osswald A, Schmack B, Goldwasser R, Kreusser MM, Raake PW, Karck M, Ruhparwar A. Impella 5.0 ® as bridge-to-recovery short-term mechanical circulatory support after LVAD explantation. J Thorac Dis 2019; 11:S960-S962. [PMID: 31183176 DOI: 10.21037/jtd.2019.04.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anja Osswald
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ranny Goldwasser
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Philip W Raake
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
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20
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Schmack B, Farag M, Kremer J, Grossekettler L, Brcic A, Raake PW, Kreusser MM, Goldwasser R, Popov AF, Mansur A, Karck M, Ruhparwar A. Results of concomitant groin-free percutaneous temporary RVAD support using a centrifugal pump with a double-lumen jugular venous cannula in LVAD patients. J Thorac Dis 2019; 11:S913-S920. [PMID: 31183170 DOI: 10.21037/jtd.2018.11.121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Modern left ventricular assist devices (LVAD) have evolved to become standard of care in severe heart failure (HF) patients. Right HF (RHF) is a major complication responsible for early mortality. Several techniques for temporary right ventricular assist device (t-RVAD) have been described before, baring relevant disadvantages such as limited mobilization or the need for re-thoracotomy. We describe the results of an alternative technique for t-RVAD using the Tandem Heart™ with ProtekDuo™ cannula. Methods An institutional retrospective single centre outcome analysis was performed including all permanent LVAD recipients with concomitant groin-free t-RVAD support. Results Between October 2015 and September 2017, 11 patients (10 male, 90.9%) were included. Preoperative NYHA class was 3.8±0.75 and INTERMACS class 3.5±1.5. Four (36.4%) patients were already on mechanical circulatory support (MCS) at time of implantation with 4 (36.4%) patients already on inotropic support. All LVAD implantations were performed on-pump and 3 cases (27.3%) were re-do cases. Mean t-RVAD duration was 16.8±9.5 days. Ten patients (90.9%) could be weaned from temporary RVAD support, 1 patient deceased on support. Mean ICU stay was 23.8±16.5 days, while 30-day survival was 72.7%. Follow-up was complete with 214.7±283 days. Three patients (27.3%) died following multi-organ failure (MOF), 1 patient (9.1%) following intracranial bleed 12 days after t-RVAD explantation. No severe t-RVAD associated complications were observed. Conclusions Our technique allows for safe groin-free t-RVAD providing all advantages of percutaneous implantation including complete mobilization and bedside explantation without any need for operation.
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Affiliation(s)
- Bastian Schmack
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Andreas Brcic
- Department of Anaesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, Angiology, Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ranny Goldwasser
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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21
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Nickel AG, Kohlhaas M, Bertero E, Wilhelm D, Wagner M, Sequeira V, Kreusser MM, Dewenter M, Kappl R, Hoth M, Dudek J, Backs J, Maack C. CaMKII does not control mitochondrial Ca 2+ uptake in cardiac myocytes. J Physiol 2019; 598:1361-1376. [PMID: 30770570 DOI: 10.1113/jp276766] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/13/2019] [Indexed: 01/26/2023] Open
Abstract
KEY POINTS Mitochondrial Ca2+ uptake stimulates the Krebs cycle to regenerate the reduced forms of pyridine nucleotides (NADH, NADPH and FADH2 ) required for ATP production and reactive oxygen species (ROS) elimination. Ca2+ /calmodulin-dependent protein kinase II (CaMKII) has been proposed to regulate mitochondrial Ca2+ uptake via mitochondrial Ca2+ uniporter phosphorylation. We used two mouse models with either global deletion of CaMKIIδ (CaMKIIδ knockout) or cardiomyocyte-specific deletion of CaMKIIδ and γ (CaMKIIδ/γ double knockout) to interrogate whether CaMKII controls mitochondrial Ca2+ uptake in isolated mitochondria and during β-adrenergic stimulation in cardiac myocytes. CaMKIIδ/γ did not control Ca2+ uptake, respiration or ROS emission in isolated cardiac mitochondria, nor in isolated cardiac myocytes, during β-adrenergic stimulation and pacing. The results of the present study do not support a relevant role of CaMKII for mitochondrial Ca2+ uptake in cardiac myocytes under physiological conditions. ABSTRACT Mitochondria are the main source of ATP and reactive oxygen species (ROS) in cardiac myocytes. Furthermore, activation of the mitochondrial permeability transition pore (mPTP) induces programmed cell death. These processes are essentially controlled by Ca2+ , which is taken up into mitochondria via the mitochondrial Ca2+ uniporter (MCU). It was recently proposed that Ca2+ /calmodulin-dependent protein kinase II (CaMKII) regulates Ca2+ uptake by interacting with the MCU, thereby affecting mPTP activation and programmed cell death. In the present study, we investigated the role of CaMKII under physiological conditions in which mitochondrial Ca2+ uptake matches energy supply to the demand of cardiac myocytes. Accordingly, we measured mitochondrial Ca2+ uptake in isolated mitochondria and cardiac myocytes harvested from cardiomyocyte-specific CaMKII δ and γ double knockout (KO) (CaMKIIδ/γ DKO) and global CaMKIIδ KO mice. To simulate a physiological workload increase, cardiac myocytes were subjected to β-adrenergic stimulation (by isoproterenol superfusion) and an increase in stimulation frequency (from 0.5 to 5 Hz). No differences in mitochondrial Ca2+ accumulation were detected in isolated mitochondria or cardiac myocytes from both CaMKII KO models compared to wild-type littermates. Mitochondrial redox state and ROS production were unchanged in CaMKIIδ/γ DKO, whereas we observed a mild oxidation of mitochondrial redox state and an increase in H2 O2 emission from CaMKIIδ KO cardiac myocytes exposed to an increase in workload. In conclusion, the results obtained in the present study do not support the regulation of mitochondrial Ca2+ uptake via the MCU or mPTP activation by CaMKII in cardiac myocytes under physiological conditions.
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Affiliation(s)
- Alexander G Nickel
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany.,Affiliation when/at which experiments were performed: Clinic III for Internal Medicine, University Clinic Homburg, Homburg, Germany
| | - Michael Kohlhaas
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany.,Affiliation when/at which experiments were performed: Clinic III for Internal Medicine, University Clinic Homburg, Homburg, Germany
| | - Edoardo Bertero
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Daniel Wilhelm
- Affiliation when/at which experiments were performed: Clinic III for Internal Medicine, University Clinic Homburg, Homburg, Germany
| | - Michael Wagner
- Affiliation when/at which experiments were performed: Clinic III for Internal Medicine, University Clinic Homburg, Homburg, Germany.,Institute for Molecular Cell Biology, Saarland University, Homburg, Germany
| | - Vasco Sequeira
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Michael M Kreusser
- Institute of Experimental Cardiology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Germany.,Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Dewenter
- Institute of Experimental Cardiology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Germany
| | - Reinhard Kappl
- Department of Biophysics, CIPMM, School of Medicine, Saarland University, Homburg, Germany
| | - Markus Hoth
- Department of Biophysics, CIPMM, School of Medicine, Saarland University, Homburg, Germany
| | - Jan Dudek
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Germany
| | - Christoph Maack
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
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22
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Hamed S, Schmack B, Mueller F, Ehlermann P, Hittmann D, Ruhparwar A, Katus HA, Raake PW, Kreusser MM. Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices. Clin Res Cardiol 2019; 108:1197-1207. [DOI: 10.1007/s00392-019-01451-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
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23
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Grossekettler L, Schmack B, Meyer K, Brockmann C, Wanninger R, Kreusser MM, Frankenstein L, Kihm LP, Zeier M, Katus HA, Remppis A, Schwenger V. Peritoneal dialysis as therapeutic option in heart failure patients. ESC Heart Fail 2019; 6:271-279. [PMID: 30815994 PMCID: PMC6437425 DOI: 10.1002/ehf2.12411] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/06/2019] [Indexed: 12/30/2022] Open
Abstract
Aims Each episode of acute decompensated heart failure (HF) incrementally adds to mortality. Peritoneal dialysis (PD) offers an alternative therapeutic option in refractory HF and reduces the incidence of decompensation episodes. The objective of this study was to determine the efficacy of PD, in terms of functional status, surrogate endpoints, rate of hospitalizations, and mortality. Methods and results This study is based on the registry of the German Society of Nephrology, involving 159 patients receiving PD treatment due to refractory HF between January 2010 and December 2014. Body weight was reduced by PD (82.2 ± 14.9 to 78.4 ± 14.8 kg, P < 0.001), and significant improvements in New York Heart Association functional class (3.38 ± 0.55 to 2.85 ± 0.49, P < 0.001) were found already after 3 months. Left ventricular ejection fraction did not change (31.5 ± 13.8 to 34.0 ± 15.7%, P = 0.175). C‐reactive protein improved with PD treatment (33.7 ± 52.6 to 17.1 ± 26.3 mg/L, P = 0.004). Blood urea nitrogen/creatinine ratio decreased significantly (148.7 ± 68.3 to 106.7 ± 44.8 mg/dL, P < 0.001). Hospitalization rates decreased significantly (total number 2.86 ± 1.88 to 1.90 ± 1.78, P = 0.001, and 39.2 ± 30.7 to 27.1 ± 25.2 days, P = 0.004). One year mortality was 39.6% in end‐stage HF patients treated with PD. Conclusions Peritoneal dialysis offers an additional therapeutic option in end‐stage HF and is associated with improved New York Heart Association classification and reduced hospitalization. Although PD treatment was associated with various benefits, further studies are necessary to identify which patients benefit the most from PD.
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Affiliation(s)
- Leonie Grossekettler
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Bastian Schmack
- Clinic for Cardiac Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katrin Meyer
- Clinic for Cardiology, Heart and Vascular Center, Bad Bevensen, Germany
| | | | | | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lars P Kihm
- Department of Internal Medicine I, Endocrinology and Nephrology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Internal Medicine I, Endocrinology and Nephrology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andrew Remppis
- Clinic for Cardiology, Heart and Vascular Center, Bad Bevensen, Germany
| | - Vedat Schwenger
- Department of Internal Medicine I, Endocrinology and Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.,Department of Kidney, Blood Pressure and Autoimmune Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
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24
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Gomes B, Bekeredjian R, Leuschner F, Ehlermann P, Schmack B, Ruhparwar A, Raake PW, Katus HA, Kreusser MM. Transfemoral aortic valve replacement for severe aortic valve regurgitation in a patient with a pulsatile-flow biventricular assist device. ESC Heart Fail 2018; 6:217-221. [PMID: 30479049 PMCID: PMC6351890 DOI: 10.1002/ehf2.12384] [Citation(s) in RCA: 2] [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: 06/15/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022] Open
Abstract
Severe aortic regurgitation (AR) is a rare but significant complication of ventricular assist device therapy. Experience with transcatheter aortic valve replacement (TAVR) in this setting of patients is very limited, while the scarcely reported cases exclusively refer to TAVR under continuous‐flow left ventricular assist devices. Here, we present the first successful TAVR while running a pulsatile‐flow biventricular assist device (PF‐BiVAD). Clinical data were collected based on the patient's electronic medical records after the patient's consent was obtained. We describe the case of a 57‐year‐old man in whom a PF‐BiVAD (EXCOR, Berlin Heart, Berlin, Germany) had been initially inserted after fulminant myocarditis with subsequent severe dilated cardiomyopathy as bridge‐to‐transplantation therapy. Over the following 2 years, the patient developed severe de novo AR under PF‐BiVAD therapy. This, along with progressive cardiac decompensation, led to the decision for TAVR by our heart team as a minimal invasive approach for severe AR. TAVR using two Edwards SAPIEN 3 bioprostheses as a valve‐in‐valve procedure resulted in a significant reduction of AR from severe to mild, with trace paravalvular leakage and without significant pressure gradients. The patient underwent total orthotopic heart transplantation afterwards. This is the first report of successful TAVR in a patient with severe de novo AR while running a PF‐BiVAD.
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Affiliation(s)
- Bruna Gomes
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Florian Leuschner
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.,Department of Internal Medicine, Kurpfalzkrankenhaus, Heidelberg, Germany
| | - Bastian Schmack
- Department of Internal Medicine, Kurpfalzkrankenhaus, Heidelberg, Germany
| | - Arjang Ruhparwar
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.,Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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25
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Geis NA, Pleger ST, Bekeredjian R, Chorianopoulos E, Kreusser MM, Frankenstein L, Ruhparwar A, Katus HA, Raake PWJ. Haemodynamic effects of percutaneous mitral valve edge-to-edge repair in patients with end-stage heart failure awaiting heart transplantation. ESC Heart Fail 2018; 5:892-901. [PMID: 30058757 PMCID: PMC6165942 DOI: 10.1002/ehf2.12313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/20/2017] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022] Open
Abstract
Aims Functional mitral regurgitation is complicating end‐stage heart failure and potential heart transplantation by increasing pulmonary artery pressures. The aim of the present study was to investigate feasibility and haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair using the MitraClip™ device in patients with end‐stage heart failure awaiting heart transplantation. Methods and results In this retrospective study, we identified nine patients suffering from end‐stage heart failure listed for heart transplantation in whom moderate–severe or severe functional mitral regurgitation was recognized and treated with percutaneous mitral valve edge‐to‐edge repair. Twenty‐two patients listed for heart transplantation and presenting with moderate–severe or severe functional mitral regurgitation treated in the pre‐MitraClip™ era served as controls. Patients were analysed at two separate time points: MitraClip™ group: pre‐procedure and post‐procedure (follow‐up: 215 ± 53 days) and control group: study entry with recognition of moderate–severe or severe functional mitral regurgitation (follow‐up: 197 ± 47 days). Percutaneous mitral valve edge‐to‐edge repair with the MitraClip™ was feasible and safe in our high‐risk end‐stage heart failure population. The intervention resulted in significant reduction of mitral regurgitation (grade 3.0 [0.5] to 1.5 [0.5]; P = 0.009), left atrial diameter (51 mm [16] to 49 mm [4]; follow‐up MitraClip™ vs. control group P = 0.0497), pulmonary artery pressures (sPA 50 mmHg [15] to 45 mmHg [10]; P = 0.02; mPA 34 mmHg [8] to 30 mmHg [10]; P = 0.02), and New York Heart Association class (3.5 [1.0] to 3.0 [0.5]; P = 0.01) and improved mixed‐venous oxygen saturation (57% [11] to 55% [7]; follow‐up MitraClip™ vs. control group P = 0.02). No changes in the control group were observed. Conclusions MitraClip™ implantation as ‘bridge‐to‐transplant’ strategy in patients with end‐stage heart failure and severe functional mitral regurgitation awaiting heart transplantation is feasible and appears to result in favourable haemodynamic effects.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Emmanuel Chorianopoulos
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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26
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Kreusser MM, Tschierschke R, Beckendorf J, Baxmann T, Frankenstein L, Dösch AO, Schultz JH, Giannitsis E, Pleger ST, Ruhparwar A, Karck M, Katus HA, Raake PW. The need for dedicated advanced heart failure units to optimize heart failure care: impact of optimized advanced heart failure unit care on heart transplant outcome in high-risk patients. ESC Heart Fail 2018; 5:1108-1117. [PMID: 29984916 PMCID: PMC6300823 DOI: 10.1002/ehf2.12314] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/31/2022] Open
Abstract
Aim With an increasing prevalence of heart failure (HF), more patients with advanced disease have to be treated in cardiology units by sophisticated medical and interventional strategies. We therefore developed a dedicated advanced heart failure unit (AHFU) to target the specific needs of the many patients with advanced HF. We here present our concept and its impact on outcome in high‐risk high‐urgency (HU) heart transplant candidates. Methods and results The eight‐bed unit was established as an extension of the cardiologic intensive care and coronary care units in an intermediate care setting. Each bed was equipped with 24 h haemodynamic, respiratory, and arrhythmia monitoring. The unit is served 24/7 by five residents in cardiology, one staff cardiologist specializing in medical and interventional HF care, and 10 intensive care nurses. The cardiology team is supported by colleagues from cardiac surgery, sports medicine, psychosomatics, and the internal medicine departments. As an example of the intensified care on the AHFU, data from the cohorts of patients undergoing heart transplantation from HU status before (pre‐AHFU 2008–11) and after establishment of the AHFU (AHFU 2012–15) were analysed. Interestingly, mortality on HU waiting list and post‐heart transplant survival was comparable in both cohorts, despite significant increase in morbidity and co‐morbidity as assessed by the Index for Mortality Prediction After Cardiac Transplantation model in the AHFU group. Conclusions Our AHFU provides a unique and novel setting for the integration of modern pharmacological, interventional, surgical, and supportive HF therapy embedded in an academic heart centre. This may be a major step forward in the care of critical patients with advanced HF.
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Affiliation(s)
- Michael M Kreusser
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ramon Tschierschke
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Jan Beckendorf
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Tobias Baxmann
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andreas O Dösch
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Arjang Ruhparwar
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.,Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany.,Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Philip W Raake
- Department of Internal Medicine III (Cardiology, Angiology and Pneumology), University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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27
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Kristen AV, Kreusser MM, Blum P, Schönland SO, Frankenstein L, Dösch AO, Knop B, Helmschrott M, Schmack B, Ruhparwar A, Hegenbart U, Katus HA, Raake PW. Improved outcomes after heart transplantation for cardiac amyloidosis in the modern era. J Heart Lung Transplant 2018; 37:611-618. [DOI: 10.1016/j.healun.2017.11.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 01/01/2023] Open
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28
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Kreusser MM, Lehmann LH, Wolf N, Keranov S, Jungmann A, Gröne HJ, Müller OJ, Katus HA, Backs J. Inducible cardiomyocyte-specific deletion of CaM kinase II protects from pressure overload-induced heart failure. Basic Res Cardiol 2016; 111:65. [PMID: 27683174 DOI: 10.1007/s00395-016-0581-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
Abstract
CaM kinase II (CaMKII) has been suggested to drive pathological cardiac remodeling and heart failure. However, the evidence provided so far is based on inhibitory strategies using chemical compounds and peptides that also exert off-target effects and followed exclusively preventive strategies. Therefore, the aim of this study was to investigate whether specific CaMKII inhibition after the onset of cardiac stress delays or reverses maladaptive cardiac remodeling and dysfunction. Combined genetic deletion of the two redundant CaMKII genes δ and γ was induced after the onset of overt heart failure as the result of pathological pressure overload induced by transverse aortic constriction (TAC). We used two different strategies to engineer an inducible cardiomyocyte-specific CaMKIIδ/CaMKIIγ double knockout mouse model (DKO): one model bases on tamoxifen-inducible mER/Cre/mER expression under control of the cardiac-specific αMHC promoter; the other strategy bases on overexpression of Cre recombinase via cardiac-specific gene transfer through adeno-associated virus (AAV9) under control of the cardiac-specific myosin light chain promoter. Both models led to a substantial deletion of CaMKII in failing hearts. To approximate the clinical situation, CaMKII deletion was induced 3 weeks after TAC surgery. In both models of DKO, the progression of cardiac dysfunction and interstitial fibrosis could be slowed down as compared to control animals. Taken together, we show for the first time that "therapeutic" CaMKII deletion after cardiac damage is sufficient to attenuate maladaptive cardiac remodeling and to reverse signs of heart failure. These data suggest that CaMKII inhibition is a promising therapeutic approach to combat heart failure.
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Affiliation(s)
- Michael M Kreusser
- Department of Molecular Cardiology and Epigenetics, University of Heidelberg, Im Neuenheimer Feld 669, 69120, Heidelberg, Germany.,Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Lorenz H Lehmann
- Department of Molecular Cardiology and Epigenetics, University of Heidelberg, Im Neuenheimer Feld 669, 69120, Heidelberg, Germany.,Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Nora Wolf
- Department of Molecular Cardiology and Epigenetics, University of Heidelberg, Im Neuenheimer Feld 669, 69120, Heidelberg, Germany
| | - Stanislav Keranov
- Department of Molecular Cardiology and Epigenetics, University of Heidelberg, Im Neuenheimer Feld 669, 69120, Heidelberg, Germany
| | - Andreas Jungmann
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hermann-Josef Gröne
- Department of Molecular Pathology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Oliver J Müller
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Johannes Backs
- Department of Molecular Cardiology and Epigenetics, University of Heidelberg, Im Neuenheimer Feld 669, 69120, Heidelberg, Germany. .,Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany.
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29
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Weinreuter M, Kreusser MM, Beckendorf J, Schreiter FC, Leuschner F, Lehmann LH, Hofmann KP, Rostosky JS, Diemert N, Xu C, Volz HC, Jungmann A, Nickel A, Sticht C, Gretz N, Maack C, Schneider MD, Gröne HJ, Müller OJ, Katus HA, Backs J. CaM Kinase II mediates maladaptive post-infarct remodeling and pro-inflammatory chemoattractant signaling but not acute myocardial ischemia/reperfusion injury. EMBO Mol Med 2015; 6:1231-45. [PMID: 25193973 PMCID: PMC4287929 DOI: 10.15252/emmm.201403848] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
CaMKII was suggested to mediate ischemic myocardial injury and adverse cardiac remodeling. Here, we investigated the roles of different CaMKII isoforms and splice variants in ischemia/reperfusion (I/R) injury by the use of new genetic CaMKII mouse models. Although CaMKIIδC was upregulated 1 day after I/R injury, cardiac damage 1 day after I/R was neither affected in CaMKIIδ-deficient mice, CaMKIIδ-deficient mice in which the splice variants CaMKIIδB and C were re-expressed, nor in cardiomyocyte-specific CaMKIIδ/γ double knockout mice (DKO). In contrast, 5 weeks after I/R, DKO mice were protected against extensive scar formation and cardiac dysfunction, which was associated with reduced leukocyte infiltration and attenuated expression of members of the chemokine (C-C motif) ligand family, in particular CCL3 (macrophage inflammatory protein-1α, MIP-1α). Intriguingly, CaMKII was sufficient and required to induce CCL3 expression in isolated cardiomyocytes, indicating a cardiomyocyte autonomous effect. We propose that CaMKII-dependent chemoattractant signaling explains the effects on post-I/R remodeling. Taken together, we demonstrate that CaMKII is not critically involved in acute I/R-induced damage but in the process of post-infarct remodeling and inflammatory processes.
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Affiliation(s)
- Martin Weinreuter
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Jan Beckendorf
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Friederike C Schreiter
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Florian Leuschner
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz H Lehmann
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Kai P Hofmann
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Julia S Rostosky
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Nathalie Diemert
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Chang Xu
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Hans Christian Volz
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Jungmann
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Carsten Sticht
- Medical Research Center, University of Heidelberg Medical Faculty Mannheim, Mannheim, Germany
| | - Norbert Gretz
- Medical Research Center, University of Heidelberg Medical Faculty Mannheim, Mannheim, Germany
| | - Christoph Maack
- Department of Cardiology, Saarland University, Homburg, Germany
| | - Michael D Schneider
- British Heart Foundation Centre of Research Excellence, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Hermann-Josef Gröne
- Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany
| | - Oliver J Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Johannes Backs
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, Heidelberg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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Zhang M, Hagenmueller M, Riffel JH, Kreusser MM, Bernhold E, Fan J, Katus HA, Backs J, Hardt SE. Calcium/calmodulin-dependent protein kinase II couples Wnt signaling with histone deacetylase 4 and mediates dishevelled-induced cardiomyopathy. Hypertension 2014; 65:335-44. [PMID: 25489064 DOI: 10.1161/hypertensionaha.114.04467] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Activation of Wnt signaling results in maladaptive cardiac remodeling and cardiomyopathy. Recently, calcium/calmodulin-dependent protein kinase II (CaMKII) was reported to be a pivotal participant in myocardial remodeling. Because CaMKII was suggested as a downstream target of noncanonical Wnt signaling, we aimed to elucidate the role of CaMKII in dishevelled-1-induced cardiomyopathy and the mechanisms underlying its function. Dishevelled-1-induced cardiomyopathy was reversed by deletion of neither CaMKIIδ nor CaMKIIγ. Therefore, dishevelled-1-transgenic mice were crossed with CaMKIIδγ double-knockout mice. These mice displayed a normal cardiac phenotype without cardiac hypertrophy, fibrosis, apoptosis, or left ventricular dysfunction. Further mechanistic analyses unveiled that CaMKIIδγ couples noncanonical Wnt signaling to histone deacetylase 4 and myosin enhancer factor 2. Therefore, our findings indicate that the axis, consisting of dishevelled-1, CaMKII, histone deacetylase 4, and myosin enhancer factor 2, is an attractive therapeutic target for prevention of cardiac remodeling and its progression to left ventricular dysfunction.
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Affiliation(s)
- Min Zhang
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Marco Hagenmueller
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Johannes H Riffel
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Michael M Kreusser
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Elmar Bernhold
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Jingjing Fan
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Hugo A Katus
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Johannes Backs
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.)
| | - Stefan E Hardt
- From the Department of Cardiology, Angiology, and Pulmology (M.Z., M.H., J.H.R., M.M.K., E.B., J.F., H.A.K., S.E.H.) and Research Unit Cardiac Epigenetics, Department of Cardiology (M.M.K., J.B.), University of Heidelberg, Heidelberg, Germany; Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (M.Z.); DZHK (German Center for Cardiovascular Research) (M.H., J.H.R., M.M.K., H.A.K., S.E.H., M.M.K., J.B.), Partner Site Heidelberg/Mannheim, Heidelberg, Germany; and Center for Cardiac and Circulatory Diseases, Bruchsal, Germany (S.E.H.).
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31
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Kreusser MM, Lehmann LH, Riffel JH, Haass M, Maser-Gluth C, Backs J, Katus HA, Buss SJ. Aldosterone augments Na+-induced reduction of cardiac norepinephrine reuptake. Am J Physiol Heart Circ Physiol 2014; 307:H1169-77. [PMID: 25128164 DOI: 10.1152/ajpheart.00193.2014] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Impairment of the cardiac norepinephrine (NE) reuptake by the neuronal NE transporter contributes to enhanced cardiac NE net release in congestive heart failure. Elevated plasma levels of aldosterone (AL) promote sympathetic overstimulation in failing hearts by unclear mechanisms. Our aim was to evaluate if elevated AL and/or alterations in Na(+) intake regulate cardiac NE reuptake. To test the effects of AL and Na(+) on cardiac NE reuptake, Wistar rats were fed a normal-salt (NS) diet (0.2% NaCl), a low-salt (LS) diet (0.015% NaCl), or a high-salt (HS) diet (8% NaCl). Another group of animals received AL infusion alone (0.75 μg/h) or AL infusion plus HS diet. Specific cardiac [(3)H]NE uptake via the NE transporter in a Langendorff preparation and AL plasma levels were measured at different time points between 5 and 42 days of treatment. To compare these findings from healthy animals with a disease model, Dahl salt-sensitive rats were investigated as a model of congestive heart failure with endogenously elevated AL. In summary, neither exogenous nor endogenous elevations of AL alone were sufficient to reduce cardiac NE reuptake. Only the HS diet induced a reduction of NE reuptake by 26%; additional infusion of AL augmented this effect to a further reduction of NE reuptake by 36%. In concordance, Dahl salt-sensitive rats treated with a HS diet displayed elevated AL and a marked reduction of NE reuptake. We conclude that exogenous or endogenous AL elevations alone do not reduce cardiac NE reuptake, but AL serves as an additional factor that negatively regulates cardiac NE reuptake in concert with HS intake.
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Affiliation(s)
- Michael M Kreusser
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research, Heidelberg/Mannheim, Germany;
| | - Lorenz H Lehmann
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research, Heidelberg/Mannheim, Germany
| | - Johannes H Riffel
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research, Heidelberg/Mannheim, Germany
| | - Markus Haass
- Department of Cardiology, Theresienkrankenhaus, Mannheim, Germany; and
| | | | - Johannes Backs
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research, Heidelberg/Mannheim, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research, Heidelberg/Mannheim, Germany
| | - Sebastian J Buss
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research, Heidelberg/Mannheim, Germany
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32
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Kreusser MM, Lehmann LH, Keranov S, Hoting MO, Oehl U, Kohlhaas M, Reil JC, Neumann K, Schneider MD, Hill JA, Dobrev D, Maack C, Maier LS, Gröne HJ, Katus HA, Olson EN, Backs J. Cardiac CaM Kinase II genes δ and γ contribute to adverse remodeling but redundantly inhibit calcineurin-induced myocardial hypertrophy. Circulation 2014; 130:1262-73. [PMID: 25124496 DOI: 10.1161/circulationaha.114.006185] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ca(2+)-dependent signaling through CaM Kinase II (CaMKII) and calcineurin was suggested to contribute to adverse cardiac remodeling. However, the relative importance of CaMKII versus calcineurin for adverse cardiac remodeling remained unclear. METHODS AND RESULTS We generated double-knockout mice (DKO) lacking the 2 cardiac CaMKII genes δ and γ specifically in cardiomyocytes. We show that both CaMKII isoforms contribute redundantly to phosphorylation not only of phospholamban, ryanodine receptor 2, and histone deacetylase 4, but also calcineurin. Under baseline conditions, DKO mice are viable and display neither abnormal Ca(2+) handling nor functional and structural changes. On pathological pressure overload and β-adrenergic stimulation, DKO mice are protected against cardiac dysfunction and interstitial fibrosis. But surprisingly and paradoxically, DKO mice develop cardiac hypertrophy driven by excessive activation of endogenous calcineurin, which is associated with a lack of phosphorylation at the auto-inhibitory calcineurin A site Ser411. Likewise, calcineurin inhibition prevents cardiac hypertrophy in DKO. On exercise performance, DKO mice show an exaggeration of cardiac hypertrophy with increased expression of the calcineurin target gene RCAN1-4 but no signs of adverse cardiac remodeling. CONCLUSIONS We established a mouse model in which CaMKII's activity is specifically and completely abolished. By the use of this model we show that CaMKII induces maladaptive cardiac remodeling while it inhibits calcineurin-dependent hypertrophy. These data suggest inhibition of CaMKII but not calcineurin as a promising approach to attenuate the progression of heart failure.
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Affiliation(s)
- Michael M Kreusser
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Lorenz H Lehmann
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Stanislav Keranov
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Marc-Oscar Hoting
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Ulrike Oehl
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Michael Kohlhaas
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Jan-Christian Reil
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Kay Neumann
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Michael D Schneider
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Joseph A Hill
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Dobromir Dobrev
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Christoph Maack
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Lars S Maier
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Hermann-Josef Gröne
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Hugo A Katus
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Eric N Olson
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.)
| | - Johannes Backs
- From the Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (M.M.K., L.H.L., S.K., M.-O.H., U.O., J.B.); Department of Cardiology, Saarland University, Homburg, Germany (M.K., J.-C.R., C.M.); Department of Internal Medicine II, University of Regensburg, Germany (K.N., L.S.M.); British Heart Foundation Centre of Research Excellence, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, United Kingdom (M.D.S.); Department of Internal Medicine, University of Southwestern Texas Medical Center, Dallas (J.A.H.); Institute of Pharmacology, University of Duisburg-Essen, Germany (D.D.); Department of Molecular Pathology, German Cancer Research Center, Heidelberg, Germany (H.-J.G.); Department of Cardiology, University of Heidelberg, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany (H.A.K.); and the Department of Molecular Biology, University of Southwestern Texas Medical Center, Dallas (E.N.O.).
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Abstract
CaMKII has been shown to be activated during different cardiac pathological processes, and CaMKII-dependent mechanisms contribute to pathological cardiac remodeling, cardiac arrhythmias, and contractile dysfunction during heart failure. Activation of CaMKII during cardiac stress results in a broad number of biological effects such as, on the one hand, acute effects due to phosphorylation of distinct cellular proteins as ion channels and calcium handling proteins and, on the other hand, integrative mechanisms by changing gene expression. This review focuses on transcriptional and epigenetic effects of CaMKII activation during chronic cardiac remodeling. Multiple mechanisms have been described how CaMKII mediates changes in cardiac gene expression. CaMKII has been shown to directly phosphorylate components of the cardiac gene regulation machinery. CaMKII phosphorylates several transcription factors such as CREB that induces the activation of specific gene programs. CaMKII activates transcriptional regulators also indirectly by phosphorylating histone deacetylases, especially HDAC4, which in turn inhibits transcription factors that drive cardiac hypertrophy, fibrosis, and dysfunction. Recent studies demonstrate that CaMKII also phosphorylate directly histones, which may contribute to changes in gene expression. These findings of CaMKII-dependent gene regulation during cardiac remodeling processes suggest novel strategies for CaMKII-dependent “transcriptional or epigenetic therapies” to control cardiac gene expression and function. Manipulation of CaMKII-dependent signaling pathways in the settings of pathological cardiac growth, remodeling, and heart failure represents an auspicious therapeutic approach.
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Affiliation(s)
- Michael M Kreusser
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg Heidelberg, Germany ; German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Germany
| | - Johannes Backs
- Research Unit Cardiac Epigenetics, Department of Cardiology, University of Heidelberg Heidelberg, Germany ; German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Germany
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Hamdani N, Krysiak J, Kreusser MM, Neef S, Dos Remedios CG, Maier LS, Krüger M, Backs J, Linke WA. Crucial role for Ca2(+)/calmodulin-dependent protein kinase-II in regulating diastolic stress of normal and failing hearts via titin phosphorylation. Circ Res 2013; 112:664-74. [PMID: 23283722 DOI: 10.1161/circresaha.111.300105] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE Myocardial diastolic stiffness and cardiomyocyte passive force (F(passive)) depend in part on titin isoform composition and phosphorylation. Ca(2+)/calmodulin-dependent protein kinase-II (CaMKII) phosphorylates ion channels, Ca(2+)-handling proteins, and chromatin-modifying enzymes in the heart, but has not been known to target titin. OBJECTIVE To elucidate whether CaMKII phosphorylates titin and modulates F(passive) in normal and failing myocardium. METHODS AND RESULTS Titin phosphorylation was assessed in CaMKIIδ/γ double-knockout (DKO) mouse, transgenic CaMKIIδC-overexpressing mouse, and human hearts, by Pro-Q-Diamond/Sypro-Ruby staining, autoradiography, and immunoblotting using phosphoserine-specific titin-antibodies. CaMKII-dependent site-specific titin phosphorylation was quantified in vivo by mass spectrometry using stable isotope labeling by amino acids in cell culture mouse heart mixed with wild-type (WT) or DKO heart. F(passive) of single permeabilized cardiomyocytes was recorded before and after CaMKII-administration. All-titin phosphorylation was reduced by >50% in DKO but increased by up to ≈100% in transgenic versus WT hearts. Conserved CaMKII-dependent phosphosites were identified within the PEVK-domain of titin by quantitative mass spectrometry and confirmed in recombinant human PEVK-fragments. CaMKII also phosphorylated the cardiac titin N2B-unique sequence. Phosphorylation at specific PEVK/titin N2B-unique sequence sites was decreased in DKO and amplified in transgenic versus WT hearts. F(passive) was elevated in DKO and reduced in transgenic compared with WT cardiomyocytes. CaMKII-administration lowered F(passive) of WT and DKO cardiomyocytes, an effect blunted by titin antibody pretreatment. Human end-stage failing hearts revealed higher CaMKII expression/activity and phosphorylation at PEVK/titin N2B-unique sequence sites than nonfailing donor hearts. CONCLUSIONS CaMKII phosphorylates the titin springs at conserved serines/threonines, thereby lowering F(passive). Deranged CaMKII-dependent titin phosphorylation occurs in heart failure and contributes to altered diastolic stress.
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Affiliation(s)
- Nazha Hamdani
- Department of Cardiovascular Physiology, Ruhr University Bochum, Bochum, Germany
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Hamdani N, Krysiak J, Kreusser MM, Neef S, dos Remedios C, Maier LS, Backs J, Krüger M, Linke WA. Crucial Role for Ca2+/Calmodulin-Dependent Protein Kinase-II Delta in Regulating Diastolic Stress of Normal and Failing Hearts via Titin Phosphorylation. Biophys J 2013. [DOI: 10.1016/j.bpj.2012.11.129] [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: 12/01/2022] Open
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Backs J, Worst BC, Lehmann LH, Patrick DM, Jebessa Z, Kreusser MM, Sun Q, Chen L, Heft C, Katus HA, Olson EN. Selective repression of MEF2 activity by PKA-dependent proteolysis of HDAC4. ACTA ACUST UNITED AC 2012; 195:403-15. [PMID: 22042619 PMCID: PMC3206346 DOI: 10.1083/jcb.201105063] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [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] [Indexed: 01/08/2023]
Abstract
Histone deacetylase 4 (HDAC4) regulates numerous gene expression programs through its signal-dependent repression of myocyte enhancer factor 2 (MEF2) and serum response factor (SRF) transcription factors. In cardiomyocytes, calcium/calmodulin-dependent protein kinase II (CaMKII) signaling promotes hypertrophy and pathological remodeling, at least in part by phosphorylating HDAC4, with consequent stimulation of MEF2 activity. In this paper, we describe a novel mechanism whereby protein kinase A (PKA) overcomes CaMKII-mediated activation of MEF2 by regulated proteolysis of HDAC4. PKA induces the generation of an N-terminal HDAC4 cleavage product (HDAC4-NT). HDAC4-NT selectively inhibits activity of MEF2 but not SRF, thereby antagonizing the prohypertrophic actions of CaMKII signaling without affecting cardiomyocyte survival. Thus, HDAC4 functions as a molecular nexus for the antagonistic actions of the CaMKII and PKA pathways. These findings have implications for understanding the molecular basis of cardioprotection and other cellular processes in which CaMKII and PKA exert opposing effects.
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Affiliation(s)
- Johannes Backs
- Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany.
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Kreusser MM, Lehmann LH, Keranov S, Gröne JH, Katus HA, Olson EN, Backs J. Abstract P183: Cardiac Deletion of CaMKII Delta and Gamma Protects Against Heart Failure Despite Activation of Calcineurin Signaling. Circ Res 2011. [DOI: 10.1161/res.109.suppl_1.ap183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CaMKII delta and gamma are the major CaMKII genes expressed in the heart, and both are up-regulated in response to pressure overload. Recently, we have demonstrated that CaMKII delta single knockout mice are protected against cardiac hypertrophy and remodeling. However, the role of CaMKII gamma and potential redundant functions of CaMKII delta and gamma are still elusive. The aim of the present study was to evaluate the function of CaMKII delta and gamma by a cardiomyocyte-specific double knockout mouse model(delta/gamma-CKO). Strikingly, whereas delta and gamma single knockout mice displayed only slightly reduced levels of cardiac phospholamban (PLN) phosphorylation at the CaMKII phosphorylation site threonin 17, in delta/gamma-CKO mice there was almost no residual PLN-threonin-17 phosphorylation detectable. Surprisingly and in contrast to delta and gamma single knockout mice, delta/gamma-CKO mice did develop cardiac hypertrophy after transverse aortic constriction (TAC). Despite cardiac hypertrophy we observed markedly reduced cardiac fibrosis and apoptosis. Microarray analysis revealed a distinct different gene expression profile pointing to an activation of calcineurin in delta/gamma-CKO mice after TAC. Phosphorylation of calcineurin at serine 197, which leads to an inactivation of its enzymatic activity, was almost abolished in delta/gamma-CKO mice. To test the therapeutical implications of a complete myocardial CaMKII knockout, an tamoxifen-inducible knockout system was established. Knockout of CaMKII delta and gamma was induced by administration of tamoxifen three weeks after TAC surgery. Whereas control mice did develop overt heart failure and cardiac remodeling 16 weeks after TAC, delta/gamma-iCKO mice recovered from cardiac dysfunction. Taken together, our mouse genetic studies demonstrate that CaMKII delta and gamma are promising drug targets to restore cardiac function after pathological stress. These data also unmask a cross talk of CaMKII to endogenous calcineurin signaling, which results in adaptive cardiac hypertrophy and not pathological remodeling.
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Affiliation(s)
| | | | | | | | | | - Eric N Olson
- Univ of Texas Southwestern Med Cntr at Dallas, Dallas, TX
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Kristen AV, Kreusser MM, Lehmann L, Kinscherf R, Katus HA, Haass M, Backs J. Preserved norepinephrine reuptake but reduced sympathetic nerve endings in hypertrophic volume-overloaded rat hearts. J Card Fail 2006; 12:577-83. [PMID: 16952792 DOI: 10.1016/j.cardfail.2006.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 05/09/2006] [Accepted: 05/10/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND In congestive heart failure (CHF), an activation of the cardiac sympathetic nervous system results in depleted cardiac norepinephrine (NE) stores. The underlying regulatory mechanisms are discussed controversially and were investigated in the present study in CHF resulting from volume overload. METHODS AND RESULTS Aorto-caval shunt (AVS) was performed in rats. Plasma NE levels were determined by radioenzymatic assay, left ventricular NE by high-performance liquid chromatography, endothelin-1 by enzyme-linked immunosorbent assay. Tyrosine-hydroxylase (TH)- and nerve growth factor (NGF)-mRNA was determined by Northern blot analysis and ribonuclease-assay. Cardiac [3H]-NE uptake was measured in isolated perfused hearts. Glyoxylic acid-induced histofluorescence was used to quantify cardiac sympathetic nerves. Compared with sham-operated animals (SH), AVS rats were characterized by depleted cardiac NE stores and enhanced NE plasma levels. Neither TH-mRNA levels in stellate ganglia, nor cardiac [3H]-NE-uptake were reduced in AVS. The left ventricular density of sympathetic nerves was markedly decreased. Gene expression of myocardial NGF (a positive regulator of NE reuptake and cardiac sympathetic nerve density) and left ventricular endothelin-1 (a negative regulator of NE reuptake and positive regulator of cardiac NGF expression) were unchanged. CONCLUSION In volume-overloaded hypertrophic hearts, depletion of cardiac NE stores is caused by a reduction of the sympathetic nerve density, whereas cardiac NE reuptake is preserved.
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Affiliation(s)
- Arnt V Kristen
- Department of Cardiology, Medical University of Heidelberg, Heidelberg, Germany
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Buss SJ, Backs J, Kreusser MM, Hardt SE, Maser-Gluth C, Katus HA, Haass M. Spironolactone preserves cardiac norepinephrine reuptake in salt-sensitive Dahl rats. Endocrinology 2006; 147:2526-34. [PMID: 16439456 DOI: 10.1210/en.2005-1167] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An impairment of cardiac norepinephrine (NE) reuptake via the neuronal NE transporter (NET) enhances the effects of increased cardiac NE release in heart failure patients. Increasing evidence suggests that aldosterone and endothelins promote sympathetic overstimulation of failing hearts. Salt-sensitive Dahl rats (DS) fed a high-salt diet developed arterial hypertension and diastolic heart failure as well as elevated plasma levels of endothelin-1 and NE. Cardiac NE reuptake and NET-binding sites, as assessed by clearance of bolus-injected [(3)H]NE in isolated perfused rat hearts and [(3)H]mazindol binding, were reduced. Treatment of DS with the mineralocorticoid receptor antagonist spironolactone preserved the plasma levels of endothelin-1 and NE, cardiac NE reuptake, and myocardial NET density. Moreover, the ventricular function and survival of spironolactone-treated DS were significantly improved compared with untreated DS. The alpha(1)-inhibitor prazosin decreased blood pressure in DS similar to spironolactone treatment, but did not normalize the plasma levels of endothelin-1 and NE, NE reuptake, or ventricular function. In a heart failure-independent model, Wistar rats that were infused with aldosterone and fed a high-salt diet developed impaired cardiac NE reuptake. Treatment of these rats with the endothelin A receptor antagonist darusentan attenuated the impairment of NE reuptake. In conclusion, spironolactone preserves NET-dependent cardiac NE reuptake in salt-dependent heart failure. Evidence is provided that aldosterone inhibits NET function through an interaction with the endothelin system. Selective antagonism of the mineralocorticoid and/or the endothelin A receptor might represent therapeutic principles to prevent cardiac sympathetic overactivity in salt-dependent heart failure.
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Affiliation(s)
- Sebastian J Buss
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, 75390-9148, USA
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Kreusser MM, Haass M, Buss SJ, Hardt SE, Gerber SH, Kinscherf R, Katus HA, Backs J. Injection of Nerve Growth Factor Into Stellate Ganglia Improves Norepinephrine Reuptake Into Failing Hearts. Hypertension 2006; 47:209-15. [PMID: 16380518 DOI: 10.1161/01.hyp.0000200157.25792.26] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An impairment of cardiac norepinephrine reuptake through the neuronal norepinephrine transporter promotes depletion of cardiac norepinephrine stores and local cardiac sympathetic activation in heart failure. Nerve growth factor regulates differentiation and survival of adult sympathetic cells and is decreased in failing hearts. We hypothesized that injection of nerve growth factor into stellate ganglia normalizes cardiac norepinephrine homeostasis in experimental heart failure. Rats with transverse aortic constriction characterized by heart failure, depleted cardiac norepinephrine stores, and impaired cardiac norepinephrine reuptake were used as an experimental model. Nerve growth factor (20 microg) or saline was directly injected into left stellate ganglia 4 weeks after transverse aortic constriction. Thirty-two hours after injection, determinants of cardiac norepinephrine homeostasis were measured. As compared with saline, nerve growth factor refilled depleted cardiac norepinephrine stores and improved cardiac [3H]-norepinephrine uptake into isolated perfused hearts of transverse aortic constricted rats. In addition, pharmacological blockade of the norepinephrine transporter led to a higher increase in the overflow of endogenous norepinephrine from hearts of nerve growth factor-injected than saline-injected transverse aortic constricted rats. Norepinephrine transporter mRNA levels and the density of cardiac sympathetic nerves were not changed. Thirty-two hours after nerve growth factor injection, echocardiography revealed an increase in fractional shortening as compared with 2 days before injection. In conclusion, nerve growth factor attenuates local cardiac sympathetic overdrive of hypertrophic hearts by improving cardiac norepinephrine reuptake and might represent a novel therapeutic principle in the treatment of heart failure.
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