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Haertel F, Nuding S, Reisberg D, Peters M, Werdan K, Schulze PC, Ebelt H. The Prognostic Value of a Liver Function Test Using Indocyanine Green (ICG) Clearance in Patients with Multiple Organ Dysfunction Syndrome (MODS). J Clin Med 2024; 13:1039. [PMID: 38398351 PMCID: PMC10888702 DOI: 10.3390/jcm13041039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is common in intensive care units (ICUs) and is associated with high mortality. Although there have been multiple investigations into a multitude of organ dysfunctions, little is known about the role of liver dysfunction. In addition, clinical and laboratory findings of liver dysfunction may occur with a significant delay. Therefore, the aim of this study was to investigate whether a liver function test, based on indocyanine green (ICG)-clearance, contains prognostic information for patients in the early phase of MODS. METHODS The data of this analysis were based on the MODIFY study, which included 70 critically ill patients of a tertiary medical ICU in the early phase of MODS (≤24 h after diagnosis by an APACHE II score ≥ 20 and a sinus rhythm ≥ 90 beats per minute, with the following subgroups: cardiogenic (cMODS) and septic MODS (sMODS)) over a period of 18 months. ICG clearance was characterized by plasma disappearance rate = PDR (%/min); it was measured non-invasively by using the LiMON system (PULSION Medical Systems, Feldkirchen, Germany). The PDR was determined on the day of study inclusion (baseline) and after 96 h. The primary endpoint of this analysis was 28-day mortality. RESULTS ICG clearance was measured in 44 patients of the MODIFY trial cohort, of which 9 patients had cMODS (20%) and 35 patients had sMODS (80%). Mean age: 59.7 ± 16.5 years; 31 patients were men; mean APACHE II score: 33.6 ± 6.3; 28-day mortality was 47.7%. Liver function was reduced in the total cohort as measured by a PDR of 13.4 ± 6.3%/min At baseline, there were no relevant differences between survivors and non-survivors regarding ICG clearance (PDR: 14.6 ± 6.1%/min vs. 12.1 ± 6.5%/min; p = 0.21). However, survivors showed better liver function than non-survivors after 96 h (PDR: 21.9 ± 6.3%/min vs. 9.2 ± 6.3%/min, p < 0.05). Consistent with these findings, survivors but not non-survivors show a significant improvement in the PDR (7.3 ± 6.3%/min vs. -2.9 ± 2.6%/min; p < 0.01) within 96 h. In accordance, receiver-operating characteristic curves (ROCs) at 96 h but not at baseline show a link between the PDR and 28-day mortality (PDR at 96 h: AUC: 0.87, 95% CI: 0.76-0.98; p < 0.01. CONCLUSIONS In our study, we found that ICG clearance at baseline did not provide prognostic information in patients in the early stages of MODS despite being reduced in the total cohort. However, improvement of ICG clearance 96 h after ICU admission is associated with reduced 28-day mortality.
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Affiliation(s)
- Franz Haertel
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sebastian Nuding
- Department of Internal Medicine III, Cardiology University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle, Germany
- Department of Internal Medicine II, Cardiology, Hospital St. Elisabeth and St. Barbara Halle (Saale), Mauerstraße 5, 06110 Halle (Saale), Germany
| | - Diana Reisberg
- Department of pediatrics, Ameos Hospital Aschersleben, Eislebener Str. 7A, 06449 Aschersleben, Germany
| | - Martin Peters
- Department of Internal Medicine, Helios Hospital Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | - Karl Werdan
- Department of Internal Medicine III, Cardiology University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Henning Ebelt
- Department of Internal Medicine III, Cardiology University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle, Germany
- Department of Internal Medicine II, Cardiology, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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Werdan K, Nuding S, Kühnert D, Kolthoum R, Schott A, Quitter F, Wienke A, Sedding D. Treatment of patients with multiple organ dysfunction syndrome (MODS) with an electromagnetic field coupled to biorhythmically defined impulse configuration: the MicrocircMODS study. Clin Res Cardiol 2024; 113:260-275. [PMID: 37717230 PMCID: PMC10850207 DOI: 10.1007/s00392-023-02293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND To potentially improve impaired vasomotion of patients with multiple organ dysfunction syndrome (MODS), we tested whether an electromagnetic field of low flux density coupled with a biorhythmically defined impulse configuration (Physical Vascular Therapy BEMER®, PVT), in addition to standard care, is safe and feasible and might improve disturbed microcirculatory blood flow and thereby improve global haemodynamics. METHODS In a prospective, monocentric, one-arm pilot study, 10 MODS patients (APACHE II score 20-35) were included. Patients were treated, in addition to standard care, for 4 days with PVT (3 treatment periods of 8 min each day; day 1: field intensity 10.5 μT; day 2:14 μT, day 3:17.5 μT; day 4:21.0 μT). Primary endpoint was the effect of PVT on sublingual microcirculatory perfusion, documented by microvascular flow index (MFI). Patient safety, adverse events, and outcomes were documented. RESULTS An increase in MFI by approximately 25% paralleled 4-day PVT, with the increase starting immediately after the first PVT and lasting over the total 4-day treatment period. Concerning global haemodynamics (secondary endpoints), halving vasopressor use within 24 h, and haemodynamic stabilisation paralleled 4-day PVT with an increase in cardiac index, stroke volume index, and cardiac power index by 30%-50%. No adverse events (AEs) or serious adverse events (SAEs) were classified as causally related to the medical product (PVT) or study. Three patients died within 28 days and one patient between 28 and 180 days. CONCLUSION PVT treatment was feasible and safe and could be performed without obstruction of standard patient care. An increase in microcirculatory blood flow, a rapid reduction in vasopressor use, and an improvement in global haemodynamics paralleled PVT treatment. Findings of this pilot study allowed forming a concept for a randomized trial for further proof.
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Affiliation(s)
- Karl Werdan
- Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle (Saale), Germany.
| | - Sebastian Nuding
- Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle (Saale), Germany
- Hospital St. Elisabeth and St. Barbara, 06110, Halle (Saale), Germany
| | - Diethelm Kühnert
- Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle (Saale), Germany
- , 04838, Zschepplin, Germany
| | - Ramzi Kolthoum
- Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle (Saale), Germany
| | - Artjom Schott
- Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle (Saale), Germany
| | | | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry and Computer Science, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle (Saale), Germany
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Schott A, Kluttig A, Mikolajczyk R, Großkopf A, Greiser KH, Werdan K, Sedding D, Nuding S. Association of subendocardial viability ratio and mortality in the elderly population: results from the CARdiovascular disease, Living and Ageing in Halle study. J Hypertens 2024; 42:371-376. [PMID: 37732518 DOI: 10.1097/hjh.0000000000003579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES The subendocardial viability ratio (SEVR) reflects the balance of myocardial oxygen supply and demand. Low SEVR indicates a reduced subendocardial perfusion and has been shown to predict mortality in patients with kidney disease and diabetes. The aim of this study is to investigate the association of SEVR and mortality in the elderly population. METHODS We analysed data from the CARdiovascular disease, Living and Ageing in Halle (CARLA) study. SEVR was estimated noninvasively by radial artery tonometry and brachial blood pressure measurement. The study population was divided into a low (SEVR ≤130%) and normal (SEVR >130%) SEVR group. Cox-regression was used for survival analysis. RESULTS In total, 1414 participants (635 women, 779 men) aged from 50 to 87 years (mean age 67.3 years) were included in the analysis. The all-cause mortality was 22.7% during a median follow-up of 10.5 years. The unadjusted association of SEVR with all-cause mortality decreased from 3.52 (1.31-9.46) [hazard ratio (95% confidence interval) for low SEVR ≤ 130% versus normal SEVR > 130%] among those younger than 60 years to 0.86 (0.50-1.48) among those older than 80 years and from 1.81 (0.22-14.70) to 0.75 (0.30-1.91) for cardiovascular mortality. Sex-specific unadjusted analyses demonstrated an association of SEVR with all-cause and cardiovascular mortality in men [2.32 (1.61-3.34) and 2.24 (1.18-4.24)], but not in women [1.53 (0.87-2.72) and 1.14 (0.34-3.82)]. CONCLUSION Our data suggests that SEVR is an age dependent predictor for all-cause mortality, predominantly in men younger than 60 years.
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Affiliation(s)
- Artjom Schott
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, Interdisciplinary Center for Health Sciences, University Hospital Halle (Saale)
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale)
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale)
| | - Anne Großkopf
- University Clinic and Outpatient Clinic for Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale)
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Karl Werdan
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, Interdisciplinary Center for Health Sciences, University Hospital Halle (Saale)
| | - Daniel Sedding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, Interdisciplinary Center for Health Sciences, University Hospital Halle (Saale)
| | - Sebastian Nuding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, Interdisciplinary Center for Health Sciences, University Hospital Halle (Saale)
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Supthut W, Nuding S, Wienke A, Müller-Werdan U, Werdan K, Ebelt H. [Relationship between cardiac output, heart rate and microcirculation in patients with multiorgan dysfunction syndrome]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01086-9. [PMID: 38038767 DOI: 10.1007/s00063-023-01086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is one of the main causes of death in intensive care units. There is evidence that microcirculation in sepsis and coronary shock is regulated separately from hemodynamics. This study investigates the relationship between heart rate (HR), cardiac output (CO) and microcirculation in patients with MODS. METHODS This is a partial analysis of the "MODIFY study" (Reducing Elevated Heart Rate in Patients With Multiple Organ Dysfunction Syndrome [MODS] by Ivabradine). During the period 05/2010-09/2011, the microcirculation of 46 patients with septic and coronary MODS was measured using the sidestream dark field technique on the day of inclusion and 96 h later. Patients were randomized into a control and ivabradine treatment group. RESULTS Overall, there is a relevant improvement in microcirculation over time small perfused vessels, SPV [%] on day 0, d0:56.5 ± 34.2/d4:73.2 ± 22.1 (p = 0.03); perfused vessel density, PVDsmall [1/mm2] d0:7.5 ± 5.0/d4:9.8 ± 3.4 (p = 0.04); proportion of perfused vessels, PPVsmall [%] d0:51.6 ± 31.6/d4:66.7 ± 21.8 (p = 0.04); microcirculatory flow index, MFI d0:1.7 ± 1.0/d4:2.2 ± 0.7 (p = 0.05). Administration of ivabradine shows no effect. In patients with coronary MODS, there is a relevant correlation between microcirculatory parameters and cardiac output (SPV [%]: r = 0.98, p = 0.004). Patients with coronary MODS show better microcirculation values at high heart rates (> 100 bpm), while patients with septic MODS show an opposite relationship. CONCLUSION The results indicate that in critically ill patients, depending on the genesis of the MODS, there are different relationships between HF or CO values, on the one hand, and the parameters of the microcirculation, on the other.
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Affiliation(s)
- Wiebke Supthut
- Klinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
| | - Sebastian Nuding
- Medizinische Klinik II, Krankenhaus St. Elisabeth und St. Barbara, Halle (Saale), Deutschland
| | - Andreas Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin und EGZB, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Karl Werdan
- Klinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - Henning Ebelt
- Klinik für Innere Medizin II, Katholisches Krankenhaus St. Johann Nepomuk, Erfurt, Deutschland
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Eisenmann S, Lambrecht N, Dießel L, Busse C, Nuding S, Vogt A. Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series. BMC Pulm Med 2023; 23:5. [PMID: 36604710 PMCID: PMC9815052 DOI: 10.1186/s12890-022-02296-1] [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: 04/02/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) deptics an acute form of lung infjury with often severe respiratory impairment that requires invasive mechanical ventilation. Since ARDS can be caused by several distinct etiologies, correct characterization is desired and frequently challenging. Surgical lung biopsy was previously reported to be of additive value. We describe our institutional experience using transbronchial cryobiopsy (TBCB) for further characterization of severe and unexplained ARDS cases. CASE PRESENTATION We retrospectively collected data of TBCB in patients with unexplained ARDS, whether with or without ECMO-support. Between 2019 and 2020 TBCB was performed in eight patients. Decision for the intervention was decided in multidisciplinary discussion. Five patients were treated with ECMO. The median duration of invasive ventilation before TBCB was 24 days. TBCB was performed in one segment, that was prophylactically occluded by Watanabe spigot or swab after the procedure. Histology results and their contribution to further therapeutic decisions were analyzed. Histology revealed five diffuses alveolar damage, one acute fibrinoid organizing pneumonia, one cryptogenic organizing pneumonia and one lung cancer. All results contributed to the decision of further management. While no pneumothorax or severe endobronchial bleeding occurred, two delayed hematothoraces needed surgical treatment. No patients died due to TBCB. CONCLUSION TBCB is feasible in ARDS even during ECMO treatment. Histologic results can play a significant role in therapeutic and ethic discussion to guide the patients' care. Side effects should be considered and monitored.
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Affiliation(s)
- Stephan Eisenmann
- grid.461820.90000 0004 0390 1701Department of Internal Medicine I, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Nina Lambrecht
- grid.461820.90000 0004 0390 1701Department of Internal Medicine I, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Linda Dießel
- grid.461820.90000 0004 0390 1701Department of Pathology, University Hospital Halle, Magdeburger Strasse 2, 06112 Halle, Germany
| | - Christin Busse
- grid.461820.90000 0004 0390 1701Department of Pathology, University Hospital Halle, Magdeburger Strasse 2, 06112 Halle, Germany
| | - Sebastian Nuding
- Department of Internal Medicine, IIIUniversity Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Alexander Vogt
- Department of Internal Medicine, IIIUniversity Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
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Teren M, Schott A, Sedding D, Nuding S, Simm A, Großkopf A, Greiser KH, Kluttig A, Mikolajczyk R. The relationship of skin autofluorescence with diastolic function and HFA-PEFF score in a general population of older people. Nutr Metab Cardiovasc Dis 2022; 32:2112-2120. [PMID: 35637086 DOI: 10.1016/j.numecd.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Advanced glycation end-products accumulation in tissue as measured by Skin autofluorescence (SAF) is related to diastolic function in specific patient populations. This analysis aims at investigating this relationship in a general population of older persons. METHODS AND RESULTS Based on data from the CARLA cohort at first follow-up, 245 subjects were analyzed and stratified according to cardiovascular risk factors (CVRF). We used linear regression to investigate the association between diastolic function evaluated by echocardiography, HFA-PEFF score, and SAF. Univariable regression analysis showed an association of SAF with septal-E/e' (standardised beta = 1.11, 95% CI = 0.51-1.71) and A (3.42, 95% CI = 0.72-6.12), the former persisting after adjustment for age, sex and CVRF (0.67, 95% CI = 0.05-1.28). Septal-E/e' remained related to SAF only in the high cardiovascular risk stratum (1.16, 95% CI = 0.26-2.06). SAF was related to HFA-PEFF score (0.27, 95% CI = 0.10-0.43) but not after correcting for age and sex (0.16, 95% CI = 0.00-0.32) and CVRF and glomerular filtration rate (0.12, 95% CI = -0.07 - 0.27). SAF was related to the HFA-PEFF score only for participants with high cardiovascular risk (0.23, 95% CI = 0.02-0.45). CONCLUSION In a general community-dwelling older population, SAF is related to diastolic function as measured by septal-E/e'. Further research is necessary to assess if SAF is a potential screening tool for diastolic dysfunction in advanced age.
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Affiliation(s)
- Marian Teren
- Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Artjom Schott
- Department of Internal Medicine III - Cardiology, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany
| | - Daniel Sedding
- Department of Internal Medicine III - Cardiology, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany
| | - Sebastian Nuding
- Department of Internal Medicine III - Cardiology, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany
| | - Andreas Simm
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany
| | - Anne Großkopf
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Medical Faculty of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Schott A, Kluttig A, Mikolajczyk R, Greiser KH, Werdan K, Sedding D, Nuding S. Association of arterial stiffness and heart failure with preserved ejection fraction in the elderly population - results from the CARLA study. J Hum Hypertens 2022:10.1038/s41371-022-00703-y. [PMID: 35581324 DOI: 10.1038/s41371-022-00703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022]
Abstract
Arterial stiffness has been suspected as a cause of left ventricular diastolic dysfunction and may thereby contribute to the development of heart failure with preserved ejection fraction (HFpEF). However, this association is derived from a small number of studies and application of outdated criteria to diagnose HFpEF. This study aimed to investigate the association of arterial stiffness measured by the augmentation index (AIx) and criteria for diagnosing HFpEF according to the recommended HFA-PEFF score. Our analysis based on data from the first follow-up of the CARdiovascular Disease, Living and Ageing in Halle study. The current analysis included participants with available information about comorbidities and risk factors for HFpEF, parameters for calculation of the HFA-PEFF and noninvasive AIx estimated by applanation tonometry. The association of AIx and HFA-PEFF was investigated through descriptive and inductive statistics. A total of 767 participants were included in the analysis. AIx was associated with E/e', left ventricular wall thickness (LVWT), relative wall thickness, left ventricular mass index (LVMI) and NT-proBNP but not with e' or left atrial volume index. However, after adjustment for confounders, only LVMI and LVWT remained associated with AIx. Males with a high AIx had a 3.2-fold higher likelihood of HFpEF than those with a low AIx. In contrast, that association was not present in females. In summary, AIx is associated with the morphological domain of the HFA-PEFF score represented by LVMI and LVWT. Higher values of AIx are associated with a higher likelihood for HFpEF in elderly males but not in females.
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Affiliation(s)
- Artjom Schott
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany.
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Karl Werdan
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Sebastian Nuding
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care Medicine, Mid-German Heart Center, University Hospital Halle (Saale), Halle (Saale), Germany
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Haertel F, Reisberg D, Peters M, Nuding S, Schulze PC, Werdan K, Ebelt H. Predicting the Need for Renal Replacement Therapy Using a Vascular Occlusion Test and Tissue Oxygen Saturation in Patients in the Early Phase of Multiorgan Dysfunction Syndrome. J Clin Med 2022; 11:jcm11051420. [PMID: 35268511 PMCID: PMC8911273 DOI: 10.3390/jcm11051420] [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: 01/11/2022] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Acute kidney injury (AKI) is associated with an increased mortality in critically ill patients, especially in patients with multiorgan dysfunction syndrome (MODS). In daily clinical practice, the grading of AKI follows the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. In most cases, a relevant delay occurs frequently between the onset of AKI and detectable changes in creatinine levels as well as clinical symptoms. The aim of the present study was to examine whether a near infrared spectroscopy (NIRS)-based, non-invasive ischemia–reperfusion test (vascular occlusion test (VOT)) together with unprovoked (under resting conditions) tissue oxygen saturation (StO2) measurements, contain prognostic information in the early stage of MODS regarding the developing need for renal replacement therapy (RRT). Methods: Within a period of 18 months, patients at the medical intensive care unit of a tertiary university hospital with newly developed MODS (≤24 h after diagnosis, APACHE II score ≥20) were included in our study. The VOT occlusion slope (OS) and recovery slope (RS) were recorded in addition to unprovoked StO2. StO2 was determined non-invasively in the area of the thenar muscles using a bedside NIRS device. The VOT was carried out by inflating a blood pressure cuff on the upper arm. AKI stages were determined by the changes in creatinine levels, urinary output, and/or the need for RRT according to KDIGO. Results: 56 patients with MODS were included in the study (aged 62.5 ± 14.4 years, 40 men and 16 women, APACHE II score 34.5 ± 6.4). Incidences of the different AKI stages were: no AKI, 16.1% (n = 9); AKI stage I, 19.6% (n = 11); AKI stage II, 25% (n = 14); AKI stage III, 39.3% (n = 22). Thus, 39.3% of the patients (n = 22) developed the need for renal replacement therapy (AKI stage III). These patients had a significantly higher mortality over 28 days (RRT, 72% (n = 16/22) vs. no RRT, 44% (n = 15/34); p = 0.03). The mean unprovoked StO2 of all patients at baseline was 81.7 ± 11.1%, and did not differ between patients with or without the need for RRT. Patients with RRT showed significantly weaker negative values of the OS (−9.1 ± 3.7 vs. −11.7 ± 4.1%/min, p = 0.01) and lower values for the RS (1.7 ± 0.9 vs. 2.3 ± 1.6%/s, p = 0.02) compared to non-dialysis patients. Consistent with these results, weaker negative values of the OS were found in higher AKI stages (no AKI, −12.7 ± 4.1%/min; AKI stage I, −11.5 ± 3.0%/min; AKI stage II, −11.1 ± 3.3%/min; AKI stage III, −9.1 ± 3.7%/min; p = 0.021). Unprovoked StO2 did not contain prognostic information regarding the AKI stages. Conclusions: The weaker negative values of the VOT parameter OS are associated with an increased risk of developing AKI and RRT, and increased mortality in the early phase of MODS, while unprovoked StO2 does not contain prognostic information in that regard.
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Affiliation(s)
- Franz Haertel
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Correspondence: ; Tel.: +49-3641-9324-554
| | - Diana Reisberg
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Pädiatrie, Ameos Klinikum Aschersleben, Eislebener Str. 7A, 06449 Aschersleben, Germany
| | - Martin Peters
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin, Helios Klinikum Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | - Sebastian Nuding
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Krankenhaus “St. Elisabeth”, Mauerstr. 5, 06110 Halle (Saale), Germany
| | - P. Christian Schulze
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
| | - Karl Werdan
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
| | - Henning Ebelt
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Katholisches Krankenhaus “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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Hassan L, Efremov L, Großkopf A, Kartschmit N, Medenwald D, Schott A, Schmidt-Pokrzywniak A, Lacruz ME, Tiller D, Kraus FB, Greiser KH, Haerting J, Werdan K, Sedding D, Simm A, Nuding S, Kluttig A, Mikolajczyk R. Cardiovascular risk factors, living and ageing in Halle: the CARLA study. Eur J Epidemiol 2022; 37:103-116. [PMID: 34978665 PMCID: PMC8791893 DOI: 10.1007/s10654-021-00824-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
The CARLA study (Cardiovascular Disease, Living and Ageing in Halle) is a longitudinal population-based cohort study of the general population of the city of Halle (Saale), Germany. The primary aim of the cohort was to investigate risk factors for cardiovascular diseases based on comprehensive cardiological phenotyping of study participants and was extended to study factors associated with healthy ageing. In total, 1779 probands (812 women and 967 men, aged 45–83 years) were examined at baseline (2002–2005), with a first and second follow-up performed 4 and 8 years later. The response proportion at baseline was 64.1% and the reparticipation proportion for the first and second follow-up was 86% and 77% respectively. Sixty-four percent of the study participants were in retirement while 25% were full- or partially-employed and 11% were unemployed at the time of the baseline examination. The currently running third follow-up focuses on the assessment of physical and mental health, with an intensive 4 h examination program, including measurement of cardiovascular, neurocognitive, balance and gait parameters. The data collected in the CARLA Study resulted in answering various research questions in over 80 publications, of which two thirds were pooled analyses with other similar population-based studies. Due to the extensiveness of information on risk factors, subclinical conditions and evident diseases, the biobanking concept for the biosamples, the cohort representativeness of an elderly population, and the high level of quality assurance, the CARLA cohort offers a unique platform for further research on important indicators for healthy ageing.
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Affiliation(s)
- Lamiaa Hassan
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ljupcho Efremov
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Anne Großkopf
- University Clinic and Outpatient Clinic for Cardiac Surgery, Middle German Heart Centre at the University Hospital Halle, Halle, Germany
| | - Nadja Kartschmit
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Artjom Schott
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andrea Schmidt-Pokrzywniak
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maria E Lacruz
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Clinical Computing Center - Data Integration Center, University Hospital Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Karin H Greiser
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl Werdan
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Simm
- University Clinic and Outpatient Clinic for Cardiac Surgery, Middle German Heart Centre at the University Hospital Halle, Halle, Germany
| | - Sebastian Nuding
- Department of Internal Medicine III, University Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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10
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Hoyer D, Atti C, Nuding S, Vogt A, Sedding DG, Schott A. Toxic Epidermal Necrolysis Caused by Allopurinol: A Serious but Still Underestimated Adverse Reaction. Am J Case Rep 2021; 22:e932921. [PMID: 34634004 PMCID: PMC8522529 DOI: 10.12659/ajcr.932921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patient: Female, 75-year-old
Final Diagnosis: Toxic epidermal necrolysis
Symptoms: Exanthema • rash • shivers • weakness
Medication: —
Clinical Procedure: Analgesia • ciclosporine • corticosteroids • topical and systemic treatment
Specialty: Critical Care Medicine • Dermatology
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Affiliation(s)
- Daniel Hoyer
- Department of Medicine III, University Clinics of Halle (Saale), Halle (Saale), Germany
| | - Carlo Atti
- Department of Medicine III, University Clinics of Halle (Saale), Halle (Saale), Germany
| | - Sebastian Nuding
- Department of Medicine III, University Clinics of Halle (Saale), Halle (Saale), Germany
| | - Alexander Vogt
- Department of Medicine III, University Clinics of Halle (Saale), Halle (Saale), Germany
| | - Daniel G Sedding
- Department of Medicine III, University Clinics of Halle (Saale), Halle (Saale), Germany
| | - Artjom Schott
- Department of Medicine III, University Clinics of Halle (Saale), Halle (Saale), Germany
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11
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Wanek F, Meißner S, Nuding S, Hoberück S, Werdan K, Noutsias M, Ebelt H. [Influence of therapeutic temperature management on the clinical course in patients after in-hospital cardiac arrest : A retrospective analysis]. Med Klin Intensivmed Notfmed 2021; 117:297-304. [PMID: 33877423 DOI: 10.1007/s00063-021-00814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/25/2022]
Abstract
METHODS Retrospective analysis of all patients with in-hospital cardiac arrest and return of spontaneous circulation (ROSC) in the ICU of the cardiologic department of the University Hospital of Halle (Saale) between 1999 and 2009. RESULTS During the observation period, 169 patients with in-hospital cardiac arrest and information regarding temperature measurements were treated. Invasive therapeutic temperature management (TTM+) was applied in 64 patients (37.9%), while 105 patients (62.1%) underwent no therapeutic temperature management (TTM-). TTM+ and TTM- showed no relevant differences regarding patient age (TTM+: 67.6 ± 12.6 years; TTM-: 69.8 ± 12.6 years; p = 0.257), comorbidities and the initial rhythm; however, there were more men in the TTM+ group (76.6% vs. 58.1%; p = 0.015). All patients had been intubated. Time until ROSC in TTM+ was significantly longer (25.9 ± 25.8 min vs. 15.0 ± 12.4 min; p < 0.005). TTM+ resulted in a lower 30-day survival and an unfavourable neurologic outcome (Glasgow outcome scale I or II: 75% TTM+ vs. 55.2% TTM-). This negative effect persisted after adjustment for age of the patients, but not after adjustment for age and duration of reanimation (nonadjusted odds ratio for adverse neurologic outcome under TTM+: 0.411 (p = 0.011); odds ratio after adjusting for age: 0.361 (p = 0.09); odds ratio after adjusting for age and duration of the reanimation: 0.505 (p = 0.121)).
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Affiliation(s)
- Felix Wanek
- Klinik für Anästhesiologie und Intensivmedizin, Katholisches Krankenhaus Erfurt, Haarbergstraße 72, 99097, Erfurt, Deutschland.
| | - Stefanie Meißner
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Sebastian Nuding
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Sebastian Hoberück
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Michel Noutsias
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Henning Ebelt
- Klinik für Kardiologie und internistische Intensivmedizin, Erfurt, Deutschland
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12
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Abstract
BACKGROUND Demographic change, medical progress, pandemics, and mass casualty events may cause an increased demand for intensive and emergency medical care resources. There is thus a definite need for fair allocation criteria. OBJECTIVE The rationale, structure, and criteria for allocation of intensive and emergency medical care resources are presented and discussed. MATERIALS AND METHODS Analysis and discussion of German literature about the topic. RESULTS AND CONCLUSIONS Decisions on the allocation of intensive and emergency medical care resources are made on different levels (micro-, meso-, and macrolevel). They shall fulfill minimum demands in terms of procedure and content. Consequent and careful examination of indication and evidence of therapeutic decisions as well as consequent and careful examination of the patient's definite or presumed consent helps to take responsibility for fair allocation decisions.
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Affiliation(s)
- J Dutzmann
- Universitätsklinik und Poliklinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - S Nuding
- Universitätsklinik und Poliklinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
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13
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Supady A, DellaVolpe J, Taccone FS, Scharpf D, Ulmer M, Lepper PM, Halbe M, Ziegeler S, Vogt A, Ramanan R, Boldt D, Stecher SS, Montisci A, Spangenberg T, Marggraf O, Kunavarapu C, Peluso L, Muenz S, Buerle M, Nagaraj NG, Nuding S, Toma C, Gudzenko V, Stemmler HJ, Pappalardo F, Trummer G, Benk C, Michels G, Duerschmied D, von zur Muehlen C, Bode C, Kaier K, Brodie D, Wengenmayer T, Staudacher DL. Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation-A Retrospective International Multicenter Study. Membranes (Basel) 2021; 11:membranes11030170. [PMID: 33673615 PMCID: PMC7997249 DOI: 10.3390/membranes11030170] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023]
Abstract
The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V-V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.
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Affiliation(s)
- Alexander Supady
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; (D.D.); (C.v.z.M.); (C.B.); (T.W.); (D.L.S.)
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany;
- Heidelberg Institute of Global Health, University of Heidelberg, 69120 Heidelberg, Germany
- Correspondence:
| | - Jeff DellaVolpe
- Methodist Hospital, San Antonio, TX 78229, USA; (J.D.); (C.K.)
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium; (F.S.T.); (L.P.)
| | - Dominik Scharpf
- SLK-Hospital Heilbronn, 74078 Heilbronn, Germany; (D.S.); (S.M.)
| | - Matthias Ulmer
- RKH Hospital Ludwigsburg, 71640 Ludwigsburg, Germany; (M.U.); (M.B.)
| | - Philipp M. Lepper
- Department of Internal Medicine V—Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, D-66421 Homburg, Germany;
| | - Maximilian Halbe
- Heart Center, University Hospital Zurich, 8006 Zurich, Switzerland; (M.H.); (N.G.N.)
| | - Stephan Ziegeler
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Hospital Ibbenbueren, 49477 Ibbenbueren, Germany;
| | - Alexander Vogt
- Department of Medicine III, University Clinic Halle (Saale), 06097 Halle (Saale), Germany; (A.V.); (S.N.)
| | - Raj Ramanan
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; (R.R.); (C.T.)
| | - David Boldt
- UCLA Healthcare System, Los Angeles, CA 90095, USA; (D.B.); (V.G.)
| | | | - Andrea Montisci
- Istituto Clinico Sant’Ambrogio, University of Milan, 20149 Milan, Italy;
| | - Tobias Spangenberg
- Department of Cardiology, Angiology and Intensive Care, Marien Hospital Hamburg, 22087 Hamburg, Germany;
| | | | | | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium; (F.S.T.); (L.P.)
| | - Sebastian Muenz
- SLK-Hospital Heilbronn, 74078 Heilbronn, Germany; (D.S.); (S.M.)
| | - Monica Buerle
- RKH Hospital Ludwigsburg, 71640 Ludwigsburg, Germany; (M.U.); (M.B.)
| | - Naveen G. Nagaraj
- Heart Center, University Hospital Zurich, 8006 Zurich, Switzerland; (M.H.); (N.G.N.)
| | - Sebastian Nuding
- Department of Medicine III, University Clinic Halle (Saale), 06097 Halle (Saale), Germany; (A.V.); (S.N.)
| | - Catalin Toma
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; (R.R.); (C.T.)
| | - Vadim Gudzenko
- UCLA Healthcare System, Los Angeles, CA 90095, USA; (D.B.); (V.G.)
| | | | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, 90127 Palermo, Italy;
| | - Georg Trummer
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, 79106 Freiburg, Germany; (G.T.); (C.B.)
| | - Christoph Benk
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, 79106 Freiburg, Germany; (G.T.); (C.B.)
| | - Guido Michels
- Department of Acute and Emergency Care, St. Antonius Hospital Eschweiler, 52249 Eschweiler, Germany;
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; (D.D.); (C.v.z.M.); (C.B.); (T.W.); (D.L.S.)
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Constantin von zur Muehlen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; (D.D.); (C.v.z.M.); (C.B.); (T.W.); (D.L.S.)
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; (D.D.); (C.v.z.M.); (C.B.); (T.W.); (D.L.S.)
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Klaus Kaier
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany;
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY 10032, USA;
| | - Tobias Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; (D.D.); (C.v.z.M.); (C.B.); (T.W.); (D.L.S.)
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Dawid L. Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; (D.D.); (C.v.z.M.); (C.B.); (T.W.); (D.L.S.)
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany;
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Abstract
Patient: Male, 28-year-old Final Diagnosis: Clozapine poisoning Symptoms: Drowsiness • hyperventilation • impaired consciousness • respiratory insufficiency • tachycadia Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Psychiatry
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Affiliation(s)
- Amjad Daaboul
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Salle), Germany
| | - Sebastian Nuding
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Salle), Germany
| | - Artjom Schott
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Salle), Germany
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Efremov L, Lacruz ME, Tiller D, Medenwald D, Greiser KH, Kluttig A, Wienke A, Nuding S, Mikolajczyk R. Metabolically Healthy, but Obese Individuals and Associations with Echocardiographic Parameters and Inflammatory Biomarkers: Results from the CARLA Study. Diabetes Metab Syndr Obes 2020; 13:2653-2665. [PMID: 32821138 PMCID: PMC7419616 DOI: 10.2147/dmso.s263727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The research on heterogeneity among obese individuals has identified the metabolically healthy, but obese (MHO) phenotype as a distinct group that does not experience the typical cardiovascular-related diseases (CVD). It is unclear if this group differs with regard to preconditions for CVDs. Our aim was to assess differences in echocardiographic parameters and inflammatory biomarkers between MHO and metabolically healthy, normal weight individuals (MHNW). METHODS The analyses used data from 1412 elderly participants from a German population-based cohort study (CARLA), which collected detailed information on demographic, biochemical, and echocardiographic variables. Participants were subdivided into four groups (MHNW, MHO, MUNW (metabolically unhealthy, normal weight) and MUO (metabolically unhealthy, obese)) based on BMI≥30 kg/m2 (obese or normal weight) and presence of components of the metabolic syndrome. The clinical characteristics of the 4 groups were compared with ANOVA or Chi-Square test, in addition to two linear regression models for 16 echocardiographic parameters. The difference in inflammatory biomarkers (hsCRP, IL-6 and sTNF-RI) between the groups was examined with a multinomial logistic regression model. RESULTS The MHO individuals were on average 64.2±8.4 years old, with a higher proportion of women (71.6%), low percentage of smokers, larger waist circumference (109.3±10.5 cm vs 89.1±10.8 cm, p<0.0001) and higher odds ratios for hsCRP, IL-6 and sTNF-RI compared to MHNW individuals. Linear regression models revealed greater left atrial (LA) diameter (2.73 (95% CI: 1.35-4.11) mm), LA volume (7.86 (95% CI: 2.88-12.83) mL), and left ventricular mass index (LVMI) (11.82 (95% CI: 4.43-19.22) g/m1.7) in the MHO group compared to the MHNW group. CONCLUSION The MHO phenotype is associated with echocardiographic markers of cardiac remodeling (LA diameter, volume and LVMI) and higher odds ratios for inflammatory biomarkers.
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Affiliation(s)
- Ljupcho Efremov
- Institute of Medical Epidemiology, Biostatistics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Daniel Tiller
- IT Department, Data Integration Center, University Hospital Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Sebastian Nuding
- Department of Internal Medicine III, University Hospital Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Correspondence: Rafael Mikolajczyk Institute of Medical Epidemiology, Biostatistics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, Halle (Saale)06112, Germany Email
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16
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Welte T, Dellinger RP, Ebelt H, Ferrer M, Opal SM, Singer M, Vincent JL, Werdan K, Martin-Loeches I, Almirall J, Artigas A, Ignacio Ayestarán J, Nuding S, Ferrer R, Sirgo Rodríguez G, Shankar-Hari M, Álvarez-Lerma F, Riessen R, Sirvent JM, Kluge S, Zacharowski K, Bonastre Mora J, Lapp H, Wöbker G, Achtzehn U, Brealey D, Kempa A, Sánchez García M, Brederlau J, Kochanek M, Reschreiter HP, Wise MP, Belohradsky BH, Bobenhausen I, Dälken B, Dubovy P, Langohr P, Mayer M, Schüttrumpf J, Wartenberg-Demand A, Wippermann U, Wolf D, Torres A. Efficacy and safety of trimodulin, a novel polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial (CIGMA study). Intensive Care Med 2018; 44:438-448. [PMID: 29632995 PMCID: PMC5924663 DOI: 10.1007/s00134-018-5143-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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: 11/10/2017] [Accepted: 03/17/2018] [Indexed: 01/05/2023]
Abstract
Purpose The CIGMA study investigated a novel human polyclonal antibody preparation (trimodulin) containing ~ 23% immunoglobulin (Ig) M, ~ 21% IgA, and ~ 56% IgG as add-on therapy for patients with severe community-acquired pneumonia (sCAP). Methods In this double-blind, phase II study (NCT01420744), 160 patients with sCAP requiring invasive mechanical ventilation were randomized (1:1) to trimodulin (42 mg IgM/kg/day) or placebo for five consecutive days. Primary endpoint was ventilator-free days (VFDs). Secondary endpoints included 28-day all-cause and pneumonia-related mortality. Safety and tolerability were monitored. Exploratory post hoc analyses were performed in subsets stratified by baseline C-reactive protein (CRP; ≥ 70 mg/L) and/or IgM (≤ 0.8 g/L). Results Overall, there was no statistically significant difference in VFDs between trimodulin (mean 11.0, median 11 [n = 81]) and placebo (mean 9.6; median 8 [n = 79]; p = 0.173). Twenty-eight-day all-cause mortality was 22.2% vs. 27.8%, respectively (p = 0.465). Time to discharge from intensive care unit and mean duration of hospitalization were comparable between groups. Adverse-event incidences were comparable. Post hoc subset analyses, which included the majority of patients (58–78%), showed significant reductions in all-cause mortality (trimodulin vs. placebo) in patients with high CRP, low IgM, and high CRP/low IgM at baseline. Conclusions No significant differences were found in VFDs and mortality between trimodulin and placebo groups. Post hoc analyses supported improved outcome regarding mortality with trimodulin in subsets of patients with elevated CRP, reduced IgM, or both. These findings warrant further investigation. Trial registration: NCT01420744. Electronic supplementary material The online version of this article (10.1007/s00134-018-5143-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Welte
- Department of Pneumology and German Center for Lung Research (DZL), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - R Phillip Dellinger
- Department of Medicine, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, USA
| | - Henning Ebelt
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Miguel Ferrer
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - Steven M Opal
- Infectious Disease Division, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Karl Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO) Wellcome Trust - HRB Clinical Research Facility (CRF) at St. James's Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.,Critical Care Center, CIBER Enfermedades Respiratorias, Corporació Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Jordi Almirall
- Unitat de Cures Intensives, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Barcelona, Spain
| | - Antonio Artigas
- Critical Care Center, CIBER Enfermedades Respiratorias, Corporació Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Jose Ignacio Ayestarán
- Unidad de Cuidados Intensivos, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Sebastian Nuding
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Ricard Ferrer
- Hospital Universitario Mútua de Terrassa, SODIR-VHIR Research Group, Barcelona, Spain
| | - Gonzalo Sirgo Rodríguez
- Intensive Care Unit, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Rovira i Virgili University, Tarragona, Spain
| | - Manu Shankar-Hari
- Intensive Care Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Reimer Riessen
- Universitätsklinikum Tübingen, Internistische Intensivstation, Tübingen, Germany
| | - Josep-Maria Sirvent
- Servicio de Medicina Intensiva, Hospital U. Girona Dr. Josep Trueta, Avinguda França, Girona, Spain
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Juan Bonastre Mora
- Servicio de Cuidados Intensivos Adultos, Hospital Universitari y Politècnico La Fe, Valencia, Spain
| | - Harald Lapp
- 3 Medizinische Klinik, Kardiologie und Intensivmedizin, Helios Klinikum Erfurt, Erfurt, Germany
| | - Gabriele Wöbker
- Klinik für Intensivmedizin, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Ute Achtzehn
- Innere Medizin IV - Pneumologie, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - David Brealey
- Critical Care Unit, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Axel Kempa
- Klinik für Allgemeine Innere Medizin, Katharinenhospital, Stuttgart, Germany
| | | | - Jörg Brederlau
- Helios Klinikum Berlin-Buch, Klinik für Intensivmedizin, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Intensive Care Unit and Hemostasis, University Hospital of Cologne, Cologne, Germany
| | | | - Matthew P Wise
- Critical Care Unit, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Bernd H Belohradsky
- University Children's Hospital Munich, Ludwig-Maximilians University Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | - Antoni Torres
- Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona IDIBAPS, CIBERES, Barcelona, Spain
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Abstract
INTRODUCTION About 5% of patients with myocardial infarction suffer from cardiogenic shock as a complication, with a mortality of ≥30%. Primary percutaneous coronary intervention as soon as possible is the most successful therapeutic approach. Prognosis depends not only on the extent of infarction, but also - and even more - on organ hypoperfusion with consequent development of multiple organ dysfunction syndrome. Areas covered: This review covers diagnostic, monitoring and treatment concepts relevant for caring patients with cardiogenic shock complicating myocardial infarction. All major clinical trials have been selected for review of the recent data. Expert commentary: For optimal care, not only primary percutaneous intervention of the occluded coronary artery is necessary, but also best intensive care medicine avoiding the development of multiple organ dysfunction syndrome and finally death. On contrary, intra-aortic balloon pump - though used for decades - is unable to reduce mortality of patients with cardiogenic shock complicating myocardial infarction.
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Affiliation(s)
- Sebastian Nuding
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Karl Werdan
- a Department of Medicine III , University Hospital Halle (Saale) , Halle (Saale) , Germany
| | - Roland Prondzinsky
- b Department of Medicine I , Carl-von-Basedow Hospital Merseburg , Germany
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Medenwald D, Swenne CA, Frantz S, Nuding S, Kors JA, Pietzner D, Tiller D, Greiser KH, Kluttig A, Haerting J. Longitudinal association of short-term, metronome-paced heart rate variability and echocardiographically assessed cardiac structure at a 4-year follow-up: results from the prospective, population-based CARLA cohort. Europace 2017; 19:2027-2035. [PMID: 28371898 DOI: 10.1093/europace/euw296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022] Open
Abstract
Aims To assess the value of cardiac structure/function in predicting heart rate variability (HRV) and the possibly predictive value of HRV on cardiac parameters. Methods and results Baseline and 4-year follow-up data from the population-based CARLA cohort were used (790 men, 646 women, aged 45-83 years at baseline and 50-87 years at follow-up). Echocardiographic and HRV recordings were performed at baseline and at follow-up. Linear regression models with a quadratic term were used. Crude and covariate adjusted estimates were calculated. Missing values were imputed by means of multiple imputation. Heart rate variability measures taken into account consisted of linear time and frequency domain [standard deviation of normal-to-normal intervals (SDNN), high-frequency power (HF), low-frequency power (LF), LF/HF ratio] and non-linear measures [detrended fluctuation analysis (DFA1), SD1, SD2, SD1/SD2 ratio]. Echocardiographic parameters considered were ventricular mass index, diastolic interventricular septum thickness, left ventricular diastolic dimension, left atrial dimension systolic (LADS), and ejection fraction (Teichholz). A negative quadratic relation between baseline LADS and change in SDNN and HF was observed. The maximum HF and SDNN change (an increase of roughly 0.02%) was predicted at LADS of 3.72 and 3.57 cm, respectively, while the majority of subjects experienced a decrease in HRV. There was no association between further echocardiographic parameters and change in HRV, and there was no evidence of a predictive value of HRV in the prediction of changes in cardiac structure. Conclusion In the general population, LADS predicts 4-year alteration in SDNN and HF non-linearly. Because of the novelty of the result, analyses should be replicated in other populations.
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Affiliation(s)
- Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Cees A Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan Frantz
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Sebastian Nuding
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Jan A Kors
- Department of Medical Informatics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diana Pietzner
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Karin H Greiser
- German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
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19
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Abstract
PURPOSE OF REVIEW Immunosenescence has been scrutinized in detail, and evidence that inflammation and ageing are interrelated is consistent. Still, a gold standard for assessing the biological age of the immune function in an individual patient is lacking, so that immunosenescence is still not a quantifiable criterion in clinical decision-making processes. RECENT FINDINGS This review highlights recent (partly ongoing) studies into biomarkers of inflammation to assess immunosenescence, including large-scale studies, and quotes expert opinion statements. Markers of basal inflammation frequently used include interleukin-6, tumor necrosis factor-α and receptors p55 and p75, C-reactive protein and cytomegalovirus antibody levels. Some cellular markers are particularly advocated to reflect age-related decay of specific immunity, namely the decrease of naive T cells, especially CD8cells, and accumulations of memory T cells, especially late-stage differentiated CD8 cells; the loss of CD28 on lymphocytes is also taken as a biomarker of immunosenescence. SUMMARY Substantial progress has been made in both understanding and phenotyping immunosenescence and inflammageing. The diagnosis of the degree of immunosenescence in the individual patient, however, has not yet been standardized.
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Affiliation(s)
- Ursula Müller-Werdan
- aCharité - Universitätsmedizin Berlin and Protestant Geriatric Centre Berlin, BerlinbDepartment of Medicine III, University Hospital Halle (Saale) of the Martin-Luther University Halle-Wittenberg, HallecGerman Institute of Human Nutrition (DIfE) Potsdam-Rehbrücke, Section Physiology of Energy Metabolism, Potsdam-Rehbrücke, Germany
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Haertel F, Huster D, Peters M, Nuding S, Schroeder J, Werdan K, Schulze C, Ebelt H. P3485Prognostic value of a vascular occlusion test (VOT) using tissue oxygen saturation (StO2) in patients in the early phase of multi organ dysfunction syndrome (MODS). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F. Haertel
- University Hospital of Jena, Cardiology, Jena, Germany
| | - D. Huster
- Hospital Aschaffenburg, Paediatrics, Aschaffenburg, Germany
| | - M. Peters
- Helios Hospital Jerichower Land, Internal Medicine/ Intensive Care, Burg, Germany
| | - S. Nuding
- University Clinic Halle (Saale), Cardiology, Halle, Germany
| | - J. Schroeder
- University Clinic Halle (Saale), Cardiology, Halle, Germany
| | - K. Werdan
- University Clinic Halle (Saale), Cardiology, Halle, Germany
| | - C. Schulze
- University Hospital of Jena, Cardiology, Jena, Germany
| | - H. Ebelt
- Catholic Hospital “St. Nepomuk”, Internal Medicine/ Cardiology, Erfurt, Germany
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21
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Wild PS, Felix JF, Schillert A, Teumer A, Chen MH, Leening MJ, Völker U, Großmann V, Brody JA, Irvin MR, Shah SJ, Pramana S, Lieb W, Schmidt R, Stanton AV, Malzahn D, Smith AV, Sundström J, Minelli C, Ruggiero D, Lyytikäinen LP, Tiller D, Smith JG, Monnereau C, Di Tullio MR, Musani SK, Morrison AC, Pers TH, Morley M, Kleber ME, Aragam J, Benjamin EJ, Bis JC, Bisping E, Broeckel U, Cheng S, Deckers JW, Del Greco M F, Edelmann F, Fornage M, Franke L, Friedrich N, Harris TB, Hofer E, Hofman A, Huang J, Hughes AD, Kähönen M, investigators KNHI, Kruppa J, Lackner KJ, Lannfelt L, Laskowski R, Launer LJ, Leosdottir M, Lin H, Lindgren CM, Loley C, MacRae CA, Mascalzoni D, Mayet J, Medenwald D, Morris AP, Müller C, Müller-Nurasyid M, Nappo S, Nilsson PM, Nuding S, Nutile T, Peters A, Pfeufer A, Pietzner D, Pramstaller PP, Raitakari OT, Rice KM, Rivadeneira F, Rotter JI, Ruohonen ST, Sacco RL, Samdarshi TE, Schmidt H, Sharp AS, Shields DC, Sorice R, Sotoodehnia N, Stricker BH, Surendran P, Thom S, Töglhofer AM, Uitterlinden AG, Wachter R, Völzke H, Ziegler A, Münzel T, März W, Cappola TP, Hirschhorn JN, Mitchell GF, Smith NL, Fox ER, Dueker ND, Jaddoe VW, Melander O, Russ M, Lehtimäki T, Ciullo M, Hicks AA, Lind L, Gudnason V, Pieske B, Barron AJ, Zweiker R, Schunkert H, Ingelsson E, Liu K, Arnett DK, Psaty BM, Blankenberg S, Larson MG, Felix SB, Franco OH, Zeller T, Vasan RS, Dörr M. Large-scale genome-wide analysis identifies genetic variants associated with cardiac structure and function. J Clin Invest 2017; 127:1798-1812. [PMID: 28394258 PMCID: PMC5409098 DOI: 10.1172/jci84840] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/16/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Understanding the genetic architecture of cardiac structure and function may help to prevent and treat heart disease. This investigation sought to identify common genetic variations associated with inter-individual variability in cardiac structure and function. METHODS A GWAS meta-analysis of echocardiographic traits was performed, including 46,533 individuals from 30 studies (EchoGen consortium). The analysis included 16 traits of left ventricular (LV) structure, and systolic and diastolic function. RESULTS The discovery analysis included 21 cohorts for structural and systolic function traits (n = 32,212) and 17 cohorts for diastolic function traits (n = 21,852). Replication was performed in 5 cohorts (n = 14,321) and 6 cohorts (n = 16,308), respectively. Besides 5 previously reported loci, the combined meta-analysis identified 10 additional genome-wide significant SNPs: rs12541595 near MTSS1 and rs10774625 in ATXN2 for LV end-diastolic internal dimension; rs806322 near KCNRG, rs4765663 in CACNA1C, rs6702619 near PALMD, rs7127129 in TMEM16A, rs11207426 near FGGY, rs17608766 in GOSR2, and rs17696696 in CFDP1 for aortic root diameter; and rs12440869 in IQCH for Doppler transmitral A-wave peak velocity. Findings were in part validated in other cohorts and in GWAS of related disease traits. The genetic loci showed associations with putative signaling pathways, and with gene expression in whole blood, monocytes, and myocardial tissue. CONCLUSION The additional genetic loci identified in this large meta-analysis of cardiac structure and function provide insights into the underlying genetic architecture of cardiac structure and warrant follow-up in future functional studies. FUNDING For detailed information per study, see Acknowledgments.
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Affiliation(s)
- Philipp S. Wild
- Preventive Cardiology and Preventive Medicine, Department of Medicine 2, and
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- DZHK (German Centre for Cardiovascular Research), partner site RhineMain, Mainz, Germany
| | - Janine F. Felix
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Arne Schillert
- Institute for Medical Biometry and Statistics, University Lübeck, University Medical Center Schleswig-Holstein, Lübeck, Germany
- DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK, partner site Greifswald, Greifswald, Germany
| | - Ming-Huei Chen
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Maarten J.G. Leening
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Uwe Völker
- DZHK, partner site Greifswald, Greifswald, Germany
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Vera Großmann
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marguerite R. Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Setia Pramana
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Wolfgang Lieb
- Institute of Epidemiology and Popgen Biobank, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Reinhold Schmidt
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
| | - Alice V. Stanton
- Blood Pressure Unit, Beaumont Hospital, Dublin, Ireland
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dörthe Malzahn
- Department of Genetic Epidemiology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Albert Vernon Smith
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Johan Sundström
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Cosetta Minelli
- Population Health and Occupational Disease, National Heart and Lung Institute (NHLI), Imperial College London, London, United Kingdom
| | - Daniela Ruggiero
- Institute of Genetics and Biophysics A. Buzzati-Traverso, CNR, Naples, Italy
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Department of Clinical Chemistry, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - J. Gustav Smith
- Department of Cardiology, Lund University and Skåne University Hospital, Lund, Sweden
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Monnereau
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- The Generation R Study Group and
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marco R. Di Tullio
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Solomon K. Musani
- Jackson Heart Study, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Alanna C. Morrison
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tune H. Pers
- Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark
| | - Michael Morley
- Penn Cardiovascular Institute and Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcus E. Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - AortaGen Consortium
- Members of the AortaGen Consortium and their affiliations are detailed in the Supplemental Acknowledgments
| | - Jayashri Aragam
- Harvard Medical School, Boston, Massachusetts, USA
- Veteran’s Administration Hospital, West Roxbury, Boston, Massachusetts, USA
| | - Emelia J. Benjamin
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, USA
- Sections of Cardiology, Preventive Medicine and Epidemiology, Department of Medicine, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Egbert Bisping
- Department of Cardiology, Medical University Graz, Graz, Austria
| | | | | | - Susan Cheng
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, USA
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jaap W. Deckers
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fabiola Del Greco M
- Center for Biomedicine, European Academy of Bolzano/Bozen, Bolzano, Italy – Affiliated institute of the University of Lübeck, Lübeck, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Myriam Fornage
- University of Texas Health Science Center, Houston, Texas, USA
| | - Lude Franke
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Nele Friedrich
- DZHK, partner site Greifswald, Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, NIH, Bethesda, Maryland, USA
| | - Edith Hofer
- Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jie Huang
- Boston VA Research Institute, Boston, Massachusetts, USA
- Brigham and Women’s Hospital Division of Aging, Harvard Medical School, Boston, Massachusetts, USA
| | - Alun D. Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
- Department of Clinical Physiology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - KNHI investigators
- KNHI investigators and their affiliations are detailed in the Supplemental Acknowledgments
| | - Jochen Kruppa
- Institute for Medical Biometry and Statistics, University Lübeck, University Medical Center Schleswig-Holstein, Lübeck, Germany
- University of Veterinary Medicine, Foundation Institute of Veterinary Medicine and Genetics, Hannover, Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Lars Lannfelt
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Rafael Laskowski
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Lenore J. Launer
- Neuroepidemiology Section, National Institute on Aging, NIH, Bethesda, Maryland, USA
| | - Margrét Leosdottir
- Department of Cardiology, Lund University, and Skåne University Hospital, Malmö, Sweden
| | - Honghuang Lin
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Cecilia M. Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Christina Loley
- Institute for Medical Biometry and Statistics, University Lübeck, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Calum A. MacRae
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Deborah Mascalzoni
- Center for Biomedicine, European Academy of Bolzano/Bozen, Bolzano, Italy – Affiliated institute of the University of Lübeck, Lübeck, Germany
| | - Jamil Mayet
- International Centre for Circulatory Health, Hammersmith Hospital, London, United Kingdom
- NHLI, Imperial College London, London, United Kingdom
| | - Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andrew P. Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Christian Müller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Martina Müller-Nurasyid
- Department of Medicine I, Ludwig-Maximilians-University Munich, Munich, Germany
- DZHK, partner site Munich Heart Alliance, Munich, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Stefania Nappo
- Institute of Genetics and Biophysics A. Buzzati-Traverso, CNR, Naples, Italy
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Sebastian Nuding
- Department of Medicine III, University Clinics Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Teresa Nutile
- Institute of Genetics and Biophysics A. Buzzati-Traverso, CNR, Naples, Italy
| | - Annette Peters
- DZHK, partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Arne Pfeufer
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Diana Pietzner
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter P. Pramstaller
- Center for Biomedicine, European Academy of Bolzano/Bozen, Bolzano, Italy – Affiliated institute of the University of Lübeck, Lübeck, Germany
- Department of Neurology, General Central Hospital, Bolzano, Italy
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Kenneth M. Rice
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- The Generation R Study Group and
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Saku T. Ruohonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Ralph L. Sacco
- Department of Neurology and
- McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Departments of Public Health Sciences and Human Genomics, University of Miami, Miami, Florida, USA
| | - Tandaw E. Samdarshi
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Helena Schmidt
- Institute of Molecular Biology and Biochemistry, Medical University Graz, Graz, Austria
| | - Andrew S.P. Sharp
- Department of Cardiology, Royal Devon and Exeter Hospital and University of Exeter, Exeter, United Kingdom
| | - Denis C. Shields
- UCD Conway Institute of Biomolecular and Biomedical Research and
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Rossella Sorice
- Institute of Genetics and Biophysics A. Buzzati-Traverso, CNR, Naples, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Bruno H. Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Inspectorate for Health Care, Utrecht, Netherlands
| | - Praveen Surendran
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Simon Thom
- International Centre for Circulatory Health, Hammersmith Hospital, London, United Kingdom
- NHLI, Imperial College London, London, United Kingdom
| | - Anna M. Töglhofer
- Institute of Molecular Biology and Biochemistry, Medical University Graz, Graz, Austria
| | - André G. Uitterlinden
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August University, Göttingen, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK, partner site Greifswald, Greifswald, Germany
| | - Andreas Ziegler
- Institute for Medical Biometry and Statistics, University Lübeck, University Medical Center Schleswig-Holstein, Lübeck, Germany
- DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
- Zentrum für Klinische Studien, Universität Lübeck, Lübeck, Germany
| | - Thomas Münzel
- DZHK (German Centre for Cardiovascular Research), partner site RhineMain, Mainz, Germany
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Synlab Academy, Synlab Services GmbH, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Thomas P. Cappola
- Penn Cardiovascular Institute and Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joel N. Hirschhorn
- Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA
| | - Ervin R. Fox
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Nicole D. Dueker
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Vincent W.V. Jaddoe
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- The Generation R Study Group and
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Martin Russ
- Department of Medicine III, University Clinics Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Helios-Amperklinikum Dachau, Dachau, Germany
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Department of Clinical Chemistry, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Marina Ciullo
- Institute of Genetics and Biophysics A. Buzzati-Traverso, CNR, Naples, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Andrew A. Hicks
- Center for Biomedicine, European Academy of Bolzano/Bozen, Bolzano, Italy – Affiliated institute of the University of Lübeck, Lübeck, Germany
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Burkert Pieske
- Department of Cardiology, Medical University Graz, Graz, Austria
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- German Heart Institute Berlin DHZB, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Anthony J. Barron
- International Centre for Circulatory Health, Hammersmith Hospital, London, United Kingdom
- NHLI, Imperial College London, London, United Kingdom
| | - Robert Zweiker
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Heribert Schunkert
- DZHK, partner site Munich Heart Alliance, Munich, Germany
- Deutsches Herzzentrum, Technische Universität München, Munich, Germany
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kiang Liu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donna K. Arnett
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bruce M. Psaty
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
- Cardiovacular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington, USA
| | - Stefan Blankenberg
- DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Martin G. Larson
- Biostatistics Department, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Stephan B. Felix
- DZHK, partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Tanja Zeller
- DZHK, partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, USA
- Sections of Cardiology, Preventive Medicine and Epidemiology, Department of Medicine, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
| | - Marcus Dörr
- DZHK, partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
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Affiliation(s)
- Sebastian Nuding
- Department of Medicine III, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl Werdan
- Department of Medicine III, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Lacruz ME, Kluttig A, Kuss O, Tiller D, Medenwald D, Nuding S, Greiser KH, Frantz S, Haerting J. Short-term blood pressure variability - variation between arm side, body position and successive measurements: a population-based cohort study. BMC Cardiovasc Disord 2017; 17:31. [PMID: 28100183 PMCID: PMC5241970 DOI: 10.1186/s12872-017-0468-7] [Citation(s) in RCA: 21] [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: 05/25/2016] [Accepted: 01/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background Precise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and successive measurements in the setting of a population-based observational study. Additionally, we aimed to evaluate the influence of different measurement conditions on prevalence of hypertension. Methods The sample included 967 men and 812 women aged 45 to 83 years at baseline. BP was measured according to a standardized protocol with oscillometric devices including three sitting measurements at left arm, one simultaneous supine measurement at both arms, and four supine measurements at the arm with the higher BP. Hypertension was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg. Variability in SBP and DBP were analysed with sex-stratified linear covariance pattern models. Results We found that overall, no mean BP differences were measured according to arm-side, but substantial higher DBP and for men also higher SBP was observed in sitting than in supine position and there was a clear BP decline by consecutive measurement. Accordingly, the prevalence of hypertension depends strongly on the number and scheme of BP measurements taken to calculate the index values. Conclusions Thus, BP measurements should only be compared between studies applying equal measurement conditions and index calculation. Moreover, the first BP measurement should not be used to define hypertension since it overestimates BP. The mean of second and third measurement offers the advantage of better reproducibility over single measurements. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0468-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Elena Lacruz
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany.
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
| | - Oliver Kuss
- Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
| | - Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
| | - Sebastian Nuding
- Department of Medicine III, Martin-Luther University Halle-Wittenberg, Halle Saale, Germany
| | - Karin Halina Greiser
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Stefan Frantz
- Department of Medicine III, Martin-Luther University Halle-Wittenberg, Halle Saale, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
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Medenwald D, Tiller D, Nuding S, Greiser KH, Kluttig A, Frantz S, Haerting J. Educational status and differences in left ventricular mass and ejection fraction - The role of BMI and parameters related to the metabolic syndrome: A longitudinal analysis from the population-based CARLA cohort. Nutr Metab Cardiovasc Dis 2016; 26:815-823. [PMID: 27397510 DOI: 10.1016/j.numecd.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/21/2016] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Higher ventricular mass has been reported in non-white US-Americans with low educational status and in socially isolated people. To assess the impact of education on cardiac mass and function in the general population and to identify mediators. METHODS AND RESULTS Data from a German population-based sample were used (CARLA cohort, n = 1779 at baseline, n = 1436 at the four-year follow-up). Ventricular mass indexed on height (LVMI) and ejection fraction, using Teichholz's formula (EFTZ), were measured. Education was assessed using the ISCED classification. Mediator analyses were performed using the R-macro 'mediation' to compute the average direct effect and the average causal mediated effect after confounder adjustment. Sensitivity analyses for unobserved confounders were performed. Considered mediators were BMI, waist-to-hip ratio, HbA1c, and systolic and diastolic blood pressures. We found differences in LVMI and EFTZ, both at baseline and follow-up, between educational levels in women (lowest vs highest educational level: 15.6 g, 95% CI: -25.7, -5.6), but not in men. Similarly, women (lowest vs highest educational level at baseline: 3.3%, 95% CI: 0.8-5.7), but not men, of higher educational levels had a higher EFTZ of comparable magnitude at baseline and follow-up. Of the considered mediators, BMI explained 55.9% at baseline and 54.1% at follow-up of the educational effect, while other potential mediators had no significant effect. Relations remained constant between baseline and follow-up. CONCLUSIONS Women with low educational levels tend to have a higher ventricular mass and lower EF, which can be explained by a higher BMI in this group.
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Affiliation(s)
- D Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - D Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - S Nuding
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - K H Greiser
- German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg, Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - S Frantz
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - J Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
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Medenwald D, Swenne CA, Loppnow H, Kors JA, Pietzner D, Tiller D, Thiery J, Nuding S, Greiser KH, Haerting J, Werdan K, Kluttig A. Prognostic relevance of the interaction between short-term, metronome-paced heart rate variability, and inflammation: results from the population-based CARLA cohort study. Europace 2016; 19:110-118. [DOI: 10.1093/europace/euv333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 09/02/2015] [Indexed: 02/01/2023] Open
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Bohley S, Kluttig A, Werdan K, Nuding S, Greiser KH, Kuss O, Markus MRP, Schmidt CO, Völzke H, Krabbe C, Haerting J. Changes of individual perception in psychosocial stressors related to German reunification in 1989/1990 and cardiovascular risk factors and cardiovascular diseases in a population-based study in East Germany. BMJ Open 2016; 6:e008703. [PMID: 26729378 PMCID: PMC4716160 DOI: 10.1136/bmjopen-2015-008703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/21/2015] [Accepted: 11/03/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Aim was to examine the relationship between individually perceived changes in psychosocial stressors associated with German reunification and cardiovascular effects. We hypothesised that higher levels of psychosocial stress related to German reunification were associated with an increase in cardiovascular risk factors and cardiovascular diseases (CVDs). DESIGN Cross-sectional data from 2 cohort studies in East Germany were used: Cardiovascular Disease, Living and Ageing in Halle Study (CARLA), and Study of Health in Pomerania (SHIP). SETTING 2 populations in East Germany. PARTICIPANTS CARLA study: 1779 participants, aged 45-83 years at baseline (812 women), SHIP study: 4308 participants, aged 20-79 years at baseline (2193 women). PRIMARY AND SECONDARY OUTCOME MEASURES Psychosocial stressors related to reunification were operationalised by the Reunification Stress Index (RSI; scale from 0 to 10). This index was composed of questions that were related to individually perceived changes in psychosocial stressors (occupational, financial and personal) after reunification. To examine the associations between the RSI and each stressor separately with cardiovascular risk factors and CVD, regression models were used. RESULTS RSI was associated with CVD in women (RR=1.15, 95% CI 1.00 to 1.33). Cardiovascular risk factors were associated with RSI for both men and women, with strongest associations between RSI and diabetes in women (RR=1.10, 95% CI 1.01 to 1.20) and depressive disorders in men (RR=1.15, 95% CI 1.07 to 2.77). The change in occupational situation related to reunification was the major contributing psychosocial stressor. We observed a strong association with CVD in women who experienced occupational deterioration after reunification (RR=4.04, 95% CI 1.21 to 13.43). CONCLUSIONS Individually perceived deterioration of psychosocial stressors (occupational, financial and personal) related to German reunification was associated with cardiovascular risk factors and CVD. The associations were stronger for women than for men. An explanation for these findings could be that women were more often affected by unemployment after reunification. Morbidity and mortality follow-up of both cohorts could enhance the results.
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Affiliation(s)
- Stefanie Bohley
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl Werdan
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Sebastian Nuding
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | | | | | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Christine Krabbe
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Geier C, Schröder J, Tamm A, Dietz S, Nuding S, Holder K, Khandanpour Ö, Werdan K, Ebelt H. Influence of the serum levels of immunoglobulins on clinical outcomes in medical intensive-care patients. Med Klin Intensivmed Notfmed 2015; 112:30-37. [PMID: 26681382 DOI: 10.1007/s00063-015-0121-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/27/2015] [Revised: 08/30/2015] [Accepted: 09/30/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Endogenous immunoglobulins (Igs) are of fundamental importance in the host defense after microbial infections. However, the therapeutic administration of intravenous IgG (IVIgG) has not yet been shown to improve clinical outcomes in patients suffering from sepsis, and in the case of IgM-containing preparations (IVIgGMA) the positive evidence is only weak. Recently published studies implicate that Ig levels on admission could have an impact on the patient's response to IVIg treatment and on outcomes of critically ill patients. METHODS In this noninterventional study, the serum levels of IgG, IgM, and IgA were determined in 340 medical patients on ICU admission, and clinical outcomes were prospectively recorded (ICU mortality, need for renal replacement therapy (RRT), need for mechanical ventilation, substitution of coagulation factors, and amount of red cell transfusions). Patients were prospectively grouped according to their main reason for ICU admission (sepsis, respiratory failure, cardiovascular diseases, acute renal failure, postoperative condition, state after cardiopulmonal resuscitation, gastrointestinal diseases, and others). RESULTS AND DISCUSSION There was no correlation between the Ig levels on admission and ICU mortality neither in the total cohort of medical ICU patients nor in any prespecified subgroup. However, in a logistic regression model that was adjusted for APACHE II score on admission, an increase in serum IgG was associated with a reduced need for mechanical ventilation in patients suffering from cardiovascular disease. On the other hand, in patients suffering from sepsis, an increased level of IgM was linked to an increased administration of coagulation factors. CONCLUSION Our data do not support the hypothesis that serum levels of immunoglobulins are linked to mortality in medical ICU patients.
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Affiliation(s)
- C Geier
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - J Schröder
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - A Tamm
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - S Dietz
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - S Nuding
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - K Holder
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Ö Khandanpour
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - K Werdan
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - H Ebelt
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany.
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Werdan K, Ebelt H, Nuding S, Höpfner F, Stöckl G, Müller-Werdan U. Ivabradine in Combination with Metoprolol Improves Symptoms and Quality of Life in Patients with Stable Angina Pectoris: A post hoc Analysis from the ADDITIONS Trial. Cardiology 2015; 133:83-90. [PMID: 26501486 DOI: 10.1159/000439584] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Elevated heart rate can increase myocardial oxygen demand and reduce myocardial perfusion, provoking myocardial ischemia and angina symptoms. We evaluated adding ivabradine to the therapy of patients on metoprolol. METHODS ADDITIONS (prActical Daily efficacy anD safety of Procoralan® In combinaTION with betablockerS) was a multicenter, 4-month, noninterventional, prospective, open-label trial that involved stable-angina patients. Along with metoprolol, patients received ivabradine (5 or 7.5 mg, b.i.d.). We investigated the effect of ivabradine on heart rate, angina attacks, nitrate consumption, quality of life (QoL) and tolerability as well as the influence of baseline heart rate. RESULTS Heart rate fell by 19.7 ± 11.2 bpm, with an 8-fold decrease in weekly angina attacks (1.7 ± 2.2 to 0.2 ± 0.7) and nitrate consumption (2.4 ± 3.4 to 0.3 ± 0.9). Patient numbers in Canadian Cardiovascular Society class I more than doubled (i.e. from 29 to 65%) and QoL improved (the EQ-5D index and visual analog scale scores rose from 0.68 ± 0.27 to 0.84 ± 0.20 and 58.1 ± 18.4 to 72.2 ± 15.5 mm, respectively). The effect of ivabradine was greater in patients with a baseline heart rate ≥70 bpm (mean reduction in heart rate -21.2 ± 10.4 bpm, with a relative reduction in angina attacks and short-acting nitrate consumption of 87.1 and 87.2%, respectively). CONCLUSIONS Ivabradine combined with metoprolol safely and effectively reduces heart rate, angina attacks and nitrate use, and improves QoL in stable-angina patients.
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Affiliation(s)
- Karl Werdan
- Department of Medicine and Heart Centre, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
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Medenwald D, Loppnow H, Kluttig A, Nuding S, Greiser KH, Thiery J, Tiller D, Herzog B, Werdan K, Haerting J. Educational level and chronic inflammation in the elderly--the role of obesity: results from the population-based CARLA study. Clin Obes 2015; 5:256-65. [PMID: 26230620 DOI: 10.1111/cob.12107] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/29/2015] [Accepted: 06/13/2015] [Indexed: 12/21/2022]
Abstract
This study aimed to assess the mediating role of anthropometric parameters in the relation of education and inflammation in the elderly. Cross-sectional data from the population-based CARdio-vascular Disease, Living and Ageing in Halle study were used after excluding subjects with a plasma level of high-sensitive C-reactive protein (hsCRP) above 10 mg L(-1) (916 men/760 women remaining). Education was categorized in accordance with International Standard Classification of Education. As inflammation parameters, the soluble tumour necrosis factor type 1 (sTNF-R1), hsCRP and interleukin 6 (IL-6) were taken into account. Anthropometric parameters were the body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHeR). We used covariate adjusted mixed models to assess associations. Effect measures were the natural indirect effect (NIE), controlled direct effect and total effect (TE). Education was associated with sTNF-R1, hsCRP and IL-6 in men, and sTNF-R1 and hsCRP in women. Anthropometric parameters correlated with all inflammation parameters after covariate adjustment. BMI and WHeR were strong mediators of educational differences in sTNF-R1 (percentage of NIE of TE: 28% in men; 33% in women) and hsCRP (percentage of NIE of TE: 35% in men; 52% in women), while WHR was the weakest mediator. General obesity mediates roughly one-third of the association of education with chronic inflammation in the elderly.
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Affiliation(s)
- D Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - H Loppnow
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - A Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - S Nuding
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K H Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - J Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - D Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - B Herzog
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K Werdan
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - J Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Schröder J, Nuding S, Müller-Werdan U, Werdan K, Kluttig A, Russ M, Greiser KH, Kors JA, Haerting J, Medenwald D. Performance of Sokolow-Lyon index in detection of echocardiographically diagnosed left ventricular hypertrophy in a normal Eastern German population - results of the CARLA study. BMC Cardiovasc Disord 2015; 15:69. [PMID: 26169782 PMCID: PMC4501293 DOI: 10.1186/s12872-015-0066-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy (LVH) is an independent risk factor in arterial hypertension. Electrocardiographic indices like the Sokolow-Lyon index (SLI) are recommended as diagnostic screening methods for LVH. We assessed the diagnostic performance of the SLI in a cohort of a large general population. METHODS We used electrocardiographic and echocardiographic data from the prospective, population-based cohort study CARdio-vascular Disease, Living and Ageing in Halle (CARLA). Linear and logistic regression models were used to assess the association of SLI with LVH. To assess the impact of the body-mass-index (BMI), we performed interaction analyses. RESULTS AUC of SLI to predict LVH was 55.3 %, sensitivity of the SLI was 5 %, specificity 97 %. We found a significant association of SLI after covariate-adjustment with echocardiographically detected LVH (increase of left-ventricular mass index, LVMI 7.0 g/m(2) per 1 mV increase of SLI, p < 0.0001). However, this association was mainly caused by an association of SLI with the left-ventricular internal diameter (LVIDd, increase of 0.06 cm/m(2) per 1 mV increase of SLI, p < 0.0001). In obese (BMI > 30 kg/m(2)) we found the strongest association with an increase of 9.2 g/m(2) per 1 mV. CONCLUSIONS Although statistically significant, relations of SLI and echocardiographic parameters of LVH were weak and mainly driven by the increase in LVIDd, implicating a more eccentric type of LVH in the collective. The relations were strongest when obese subjects were taken into account. Our data do not favour the SLI as a diagnostic screening test to identify patients at risk for LVH, especially in non-obese subjects without eccentric LVH.
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Affiliation(s)
- Jochen Schröder
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany.
| | - Sebastian Nuding
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany.
| | - Ursula Müller-Werdan
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany. .,Clinic for Geriatric Medicine of the University Hospital RWTH Aachen, Aachen, Germany.
| | - Karl Werdan
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle / Saale, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany.
| | - Alexander Kluttig
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics and Informatics, Magdeburger Str. 8, 06112, Halle/Saale, Germany.
| | - Martin Russ
- Department of Cardiology and Pneumology, Helios Amper Kliniken Dachau, Krankenhausstr.15, 85221, Dachau, Germany.
| | - Karin H Greiser
- Division of Cancer Epidemiology, German Cancer Research Centre, Im Neuenheimer Feld 581, 69129, Heidelberg, Germany.
| | - Jan A Kors
- Department of Medical Informatics, Erasmus Medical Center Rotterdam, Kamer Na-2617, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Johannes Haerting
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics and Informatics, Magdeburger Str. 8, 06112, Halle/Saale, Germany.
| | - Daniel Medenwald
- Martin-Luther-University Halle-Wittenberg, Institute of Medical Epidemiology, Biostatistics and Informatics, Magdeburger Str. 8, 06112, Halle/Saale, Germany.
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Medenwald D, Kluttig A, Kors JA, Nuding S, Tiller D, Greiser KH, Werdan K, Haerting J. QT interval, general mortality and the role of echocardiographic parameters of left ventricular hypertrophy: Results from the prospective, population-based CARLA study. Eur J Prev Cardiol 2015; 23:428-36. [DOI: 10.1177/2047487315587271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/27/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Jan A Kors
- Department of Medical Informatics, Erasmus Medical Centre Rotterdam, The Netherlands
| | - Sebastian Nuding
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Karin H Greiser
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Karl Werdan
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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Werdan K, Ebelt H, Nuding S, Höpfner F, Stöckl G, Müller-Werdan U. Ivabradine in combination with Beta-blockers in patients with chronic stable angina after percutaneous coronary intervention. Adv Ther 2015; 32:120-37. [PMID: 25687888 PMCID: PMC4349945 DOI: 10.1007/s12325-015-0182-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Indexed: 12/28/2022]
Abstract
Introduction The anti-anginal efficacy of ivabradine is well established. We describe a post hoc analysis in the ADDITIONS database to investigate effectiveness and tolerability of ivabradine in combination with beta-blocker in patients with angina who have had a percutaneous coronary intervention (PCI). Methods ADDITIONS was a non-interventional, multicenter prospective study including 2,330 patients with stable angina. In addition to beta-blocker, patients were treated with ivabradine in approved dosages for 4 months. We divided the population according to whether they had previously had a PCI or not, and explored the effect of ivabradine on heart rate, number of weekly angina attacks, frequency of nitrate consumption, as well as quality of life (QoL) and tolerability. Results Data were available for 2,319 patients, of whom 51.4% had previously had a PCI. There was no difference in the effect of ivabradine on mean heart rate between patients with a previous PCI [64.4 ± 7.6 beats per minute (bpm)] than those without (66.8 ± 8.5 bpm) at 4 months (both P < 0.0001). Similarly, the number of angina attacks decreased from 1.9 ± 2.4 to 0.5 ± 1.5 per week in patients with a previous PCI and 1.5 ± 2.0 to 0.3 ± 1.0 per week in patients without a previous PCI (both P < 0.0001). The frequency of nitrate consumption fell from 2.7 ± 3.7 to 1.0 ± 1.9 per week and 1.8 ± 2.8 to 0.6 ± 1.5 per week (both P < 0.0001) in patients with and without a previous PCI, respectively. There was no difference in the improvements in Canadian Cardiovascular Society class of angina, QoL, and physicians’ assessment of effectiveness and tolerability between patients with a previous PCI and those without. Conclusion Ivabradine is an effective and well-tolerated anti-anginal treatment in patients with stable angina after PCI. Ivabradine reduced the frequency of weekly angina attacks and nitrate consumption, led to an improvement in Canadian Cardiovascular Society class and a substantial improvement in the QoL of stable angina patients. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0182-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karl Werdan
- Department of Medicine and Heart Centre, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany,
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Nuding S, Schröder J, Werdan K. [Cardiogenic shock]. Dtsch Med Wochenschr 2014; 139:2513-6. [PMID: 25423459 DOI: 10.1055/s-0034-1387403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Nuding
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale)
| | - J Schröder
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale)
| | - K Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale)
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Medenwald D, Girndt M, Loppnow H, Kluttig A, Nuding S, Tiller D, Thiery JJ, Greiser KH, Haerting J, Werdan K. Inflammation and renal function after a four-year follow-up in subjects with unimpaired glomerular filtration rate: results from the observational, population-based CARLA cohort. PLoS One 2014; 9:e108427. [PMID: 25259714 PMCID: PMC4178159 DOI: 10.1371/journal.pone.0108427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/20/2014] [Indexed: 12/03/2022] Open
Abstract
Background There is evidence that chronic inflammation is associated with the progression/development of chronic renal failure; however, relations in subjects with preserved renal function remain insufficiently understood. Objective To examine the association of inflammation with the development of renal failure in a cohort of the elderly general population. Methods After excluding subjects with reduced estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2) and missing data, the cohort incorporated 785 men and 659 women (aged 45–83 years). Follow-up was performed four years after baseline. Covariate adjusted linear and logistic regression models were used to assess the association of plasma/serum concentrations of soluble tumour necrosis factor receptor 1 (sTNF-R1), C-reactive protein (CRP), and interleukin 6 (IL-6) with change in eGFR/creatinine. The areas under the curve (AUCs) from receiver operating characteristics (ROCs) were estimated. Results In adjusted models sTNF-R1 was distinctively associated with a decline in eGFR in men (0.6 mL/min/1.73 m2 per 100 pg/mL sTNF-R1; 95% CI: 0.4–0.8), but not in women. A similar association could not be found for CRP or IL-6. Estimates of sTNF-R1 in the cross-sectional analyses were similar between sexes, while CRP and IL-6 were not relevantly associated with eGFR/creatinine. Conclusion In the elderly male general population with preserved renal function sTNF-R1 predicts the development of renal failure.
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Affiliation(s)
- Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- * E-mail:
| | - Matthias Girndt
- Department of Internal Medicine II, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Harald Loppnow
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Sebastian Nuding
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Joachim J. Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Karin H. Greiser
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Karl Werdan
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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Medenwald D, Dietz S, Tiller D, Kluttig A, Greiser K, Loppnow H, Thiery J, Nuding S, Russ M, Fahrig A, Haerting J, Werdan K. Inflammation and echocardiographic parameters of ventricular hypertrophy in a cohort with preserved cardiac function. Open Heart 2014; 1:e000004. [PMID: 25332774 PMCID: PMC4189296 DOI: 10.1136/openhrt-2013-000004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/01/2014] [Accepted: 01/05/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the association between inflammation and selective echocardiographic parameters (EP) characteristic for ventricular hypertrophy in cross-sectional and longitudinal population-based analyses. METHODS Baseline (711 men, 659 women: 45-83 years) and 4-year follow-up data (622 men, 540 women) of the prospective, population-based CARdio-vascular disease, Living and Ageing in Halle (CARLA)study after exclusion of participants with cardiacvascular diseases were analysed. Inflammation parameters: soluble tumour necrosis factor receptor 1 (sTNF-R1), high-sensitivity C reactive protein (hsCRP) and interleukin 6 (IL-6). EPs: left ventricular mass (LVM), left atrial systolic dimension (LADS), interventricular septum diameter (IVSD), posterior wall dimension (PWD), left ventricular diastolic diameter (LVDD), ejection fraction according to Teichholz (EF). For the longitudinal analyses baseline to follow-up differences were considered. Effect sizes were determined by using multiple linear regression and mixed models. Missing values were replaced by means of multiple imputations. RESULTS Men had higher sTNF-R1 levels; means of hsCRP and IL-6 were similar in men and women. In multiple regression models, sTNF-R1 was associated with LADS (1.4 mm/1000 pg/mL sTNF-R1, 95% CI 0.6 to 2.1) in men. Respecting confounder hsCRP was associated with LVM (5.2 g/10 mg/L hsCRP, 95% CI 1.6 to 8.8), IVSD (0.2 mm/10 mg/L hsCRP, 95% CI 0 to 0.3) and PWD (0.2 mm/10 mg/L hsCRP, 95% CI 0.1 to 0.3) in women, while there were no relevant effects in analysis of IL-6 in both sexes. The baseline to follow-up change in EPs was not relevantly associated with sTNF-R1, hsCRP or IL-6. CONCLUSIONS STNF-R1, hsCRP and IL-6 were inadequate predictors for structural changes of the heart at follow-up, while weak cross-sectional associations are restricted to certain EPs and depend on sex.
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Affiliation(s)
- D Medenwald
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - S Dietz
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - D Tiller
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - A Kluttig
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - Kh Greiser
- Division of Cancer Epidemiology , German Cancer Research Centre , Heidelberg , Germany
| | - H Loppnow
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - J Thiery
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig , Leipzig , Germany
| | - S Nuding
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - M Russ
- Department of Pneumology and Cardiology , Amper Kliniken AG, Klinikum Dachau , Dachau , Germany
| | - A Fahrig
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - J Haerting
- Biostatistics and Informatics , Institute of Medical Epidemiology, Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
| | - K Werdan
- Department of Medicine III , Martin-Luther-University Halle-Wittenberg , Halle/Saale , Germany
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Abstract
To prevent bacterial overgrowth, colonization of the epithelium and subsequent translocation, the gastrointestinal tract maintains an effective mucosal barrier. Besides mucus the most important components of this protective system are epithelial antimicrobial peptides such as defensins, the cathelicidin LL-37, lysozyme, phospholipase A, and proteins with additional antimicrobial properties such as ubiquicidin, ribosomal proteins or histones. Commensal species may tolerate intestinal antimicrobial peptides, for example Bacteroides ssp. or Parabacteroides ssp. as major species in the human colon were highly resistant to the constitutive defensin HBD-1 and only susceptible to the inducible defensin HBD-3. Reduction of disulfide bonds is an important mechanism activating HBD-1. As several studies show, alterations in the expression of antimicrobial peptides directly influence the composition of the intestinal flora. Correspondingly, an increased production of defensins or inhibition of the processing of mouse defensins to their active form led to a quantitative shift of luminal and mucosal bacterial species. On the other hand, microorganisms also modulate the synthesis of host defensins by induction or inhibition of specific peptides. Lactobacilli, the probiotic strain Escherichia coli Nissle and Salmonella enteritica stimulate HBD-2 expression, whereas Shigella flexneri downregulates the synthesis of HBD-1, HBD-3 and LL-37. Thus, the proper balance between the luminal flora and the mucosa is a permanently dynamic, sensitive and host-specific relationship.
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Affiliation(s)
- S Nuding
- University of Tübingen, Tübingen, Germany
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Werdan K, Ebelt H, Stoeckl G, Nuding S, Hoepfner F, Mueller-Werdan U. Ivabradine in combination with beta-blockers improves ejection fraction and symptom score in patients with stable angina pectoris and left ventricular dysfunction: 1-year follow-up of ADDITIONS study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Werdan K, Ebelt H, Stoeckl G, Nuding S, Hoepfner F, Mueller-Werdan U. Long-term therapy with ivabradine in combination with beta-blockers in patients with stable angina pectoris and effect of beta-blocker background dose: results from the ADDITIONS 1-year follow-up. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tiller D, Russ M, Greiser KH, Nuding S, Ebelt H, Kluttig A, Kors JA, Thiery J, Bruegel M, Haerting J, Werdan K. Prevalence of symptomatic heart failure with reduced and with normal ejection fraction in an elderly general population-the CARLA study. PLoS One 2013; 8:e59225. [PMID: 23555000 PMCID: PMC3598658 DOI: 10.1371/journal.pone.0059225] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 02/14/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES Chronic heart failure (CHF) is one of the most important public health concerns in the industrialized world having increasing incidence and prevalence. Although there are several studies describing the prevalence of heart failure with reduced ejection fraction (HFREF) and heart failure with normal ejection fraction (HFNEF) in selected populations, there are few data regarding the prevalence and the determinants of symptomatic heart failure in the general population. METHODS Cross-sectional data of a population-based German sample (1,779 subjects aged 45-83 years) were analyzed to determine the prevalence and determinants of chronic SHF and HFNEF defined according to the European Society of Cardiology using symptoms, echocardiography and serum NT-proBNP. Prevalence was age-standardized to the German population as of December 31st, 2005. RESULTS The overall age-standardized prevalence of symptomatic CHF was 7.7% (95%CI 6.0-9.8) for men and 9.0% (95%CI 7.0-11.5) for women. The prevalence of CHF strongly increased with age from 3.0% among 45-54- year-old subjects to 22.0% among 75-83- year-old subjects. Symptomatic HFREF could be shown in 48% (n = 78), symptomatic HFNEF in 52% (n = 85) of subjects with CHF. The age-standardized prevalence of HFREF was 3.8 % (95%CI 2.4-5.8) for women and 4.6 % (95%CI 3.6-6.3) for men. The age-standardized prevalence of HFNEF for women and men was 5.1 % (95%CI 3.8-7.0) and 3.0 % (95%CI 2.1-4.5), respectively. Persons with CHF were more likely to have hypertension (PR = 3.4; 95%CI 1.6-7.3) or to have had a previous myocardial infarction (PR = 2.5, 95%CI 1.8-3.5). CONCLUSION The prevalence of symptomatic CHF appears high in this population compared with other studies. While more women were affected by HFNEF than men, more male subjects suffered from HFREF. The high prevalence of symptomatic CHF seems likely to be mainly due to the high prevalence of cardiovascular risk factors in this population.
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Affiliation(s)
- Daniel Tiller
- Institute for Medical Epidemiology, Biostatistics, and Informatics Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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Bartling B, Vanhooren V, Dewaele S, Libert C, Hofmann HS, Haerting J, Nuding S, Silber RE, Simm A, Chen CC. Altered desialylated plasma N-glycan profile in patients with non-small cell lung carcinoma. Cancer Biomark 2012; 10:145-54. [PMID: 22674300 DOI: 10.3233/cbm-2012-0239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Successful therapy of the non-small cell lung carcinoma (NSCLC) depends on its early detection, and non-invasive detection methods are preferred. As plasma proteins are modified by N-linked glycosylation, we tested the importance of the N-glycan profile in diagnosing and prognosticating NSCLC. We analysed desialylated plasma samples from 75 NSCLC patients, and 71 healthy individuals by the high-throughput DNA sequencer-based carbohydrate analytical profiling technique. We detected alterations in the levels of several N-glycans in NSCLC patients. Total α-1,6-core fucosylated biantennaries (NGA2F, NG1A2F, NA2F) and total bisecting α-1,6-core fucosylated biantennaries (NGA2FB, NA2FB) were reduced in NSCLC patients, whereas the branching α-1,3-fucosylated triantennary N-glycan (NA3FB) was increased. Best diagnostic accuracy was identified for NG1A2F. NSCLC patients with TNM stage I stage did not show further differences, but patients with higher stages did (TNM II to IV). Those patients additionally had a reduced level in the α-1,6-core fucosylated structure NA2F with parallel increase in the non-fucosylated structure NA2. In this regard, NSCLC patients with a relatively low amount of NA2 per NA2F had a better three-year survival than patients with high amount. NSCLC patients show an altered N-glycan profile of plasma proteins that may be regarded as a supportive tool for cancer diagnosis.
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Affiliation(s)
- Babett Bartling
- Department of Cardio-thoracic Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Fusaro M, Fusaro M, Noale M, Tripepi G, D'angelo A, Miozzo D, Gallieni M, Study Group PV, Tsamelesvili M, Dimitriadis C, Papagianni A, Raidis C, Efstratiadis G, Memmos D, Mutluay R, Konca Degertekin C, Derici U, Deger SM, Akkiyal F, Gultekin S, Gonen S, Tacoy G, Arinsoy T, Sindel S, Sanchez-Perales C, Vazquez E, Merino E, Perez Del Barrio P, Borrego FJ, Borrego MJ, Liebana A, Krzanowski M, Janda K, Dumnicka P, Krasniak A, Sulowicz W, Kim YO, Yoon SA, Yun YS, Song HC, Kim BS, Cheong MA, Pasch A, Farese S, Floege J, Jahnen-Dechent W, Ohtake T, Ohtake T, Furuya R, Iwagami M, Tsutsumi D, Mochida Y, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Kobayashi S, Guedes A, Malho Guedes A, Pinho A, Fragoso A, Cruz A, Mendes P, Morgado E, Bexiga I, Silva AP, Neves P, Oyake N, Suzuki K, Itoh S, Yano S, Turkmen K, Kayikcioglu H, Ozbek O, Saglam M, Toker A, Tonbul HZ, Gelev S, Trajceska L, Srbinovska E, Pavleska S, Amitov V, Selim G, Dzekova P, Sikole A, Bouarich H, Lopez S, Alvarez C, Arribas I, DE Sequera P, Rodriguez D, Fusaro M, Fusaro M, Noale M, Tripepi G, D'angelo A, Miozzo D, Gallieni M, Study Group PV, Tanaka S, Kanemitsu T, Sugahara M, Kobayashi M, Uchida L, Ishimoto Y, Kotera N, Tanimoto S, Tanabe K, Hara K, Sugimoto T, Mise N, Goldstein B, Turakhia M, Arce C, Winkelmayer W, Zayed BED, Said K, Nishimura M, Nishimura M, Okamoto Y, Tokoro T, Nishida M, Hashimoto T, Iwamoto N, Takahashi H, Ono T, Nishimura M, Okamoto Y, Tokoro T, Sato N, Nishida M, Hashimoto T, Iwamoto N, Takahashi H, Ono T, Guedes A, Malho Guedes A, Cruz A, Morgado E, Pinho A, Fragoso A, Mendes P, Bexiga I, Silva AP, Neves P, Raimann J, Usvyat LA, Sands J, Levin NW, Kotanko P, Iwasaki M, Joki N, Tanaka Y, Ikeda N, Hayashi T, Kubo S, Imamura TA, Takahashi Y, Hirahata K, Imamura Y, Hase H, Claes K, Meijers B, Bammens B, Kuypers D, Naesens M, Vanrenterghem Y, Evenepoel P, Boscutti G, Calabresi L, Bosco M, Simonelli S, Boer E, Vitali C, Martone M, Mattei PL, Franceschini G, Baligh E, Zayed BED, Said K, El-Shafey E, Ezaat A, Zawada A, Rogacev K, Hummel B, Grun O, Friedrich A, Rotter B, Winter P, Geisel J, Fliser D, Heine GH, Makino JI, Makino KS, Ito T, Genovesi S, Santoro A, Fabbrini P, Rossi E, Pogliani D, Stella A, Bonforte G, Remuzzi G, Bertoli S, Pozzi C, Gallieni M, Pasquali S, Cagnoli L, Conte F, Santoro A, Buzadzic I, Tosic J, Dimkovic N, Djuric Z, Popovic J, Pejin Grubisa I, Barjaktarevic N, DI Napoli A, DI Lallo D, Salvatori MF, Franco F, Chicca S, Guasticchi G, Onofriescu M, Hogas S, Luminita V, Mugurel A, Gabriel V, Laura F, Irina M, Adrian C, Bosch E, Baamonde E, Culebras C, Perez G, El Hayek B, Ramirez JI, Ramirez A, Garcia C, Lago M, Toledo A, Checa MD, Taira T, Hirano T, Nohtomi K, Hyodo T, Chiba T, Saito A, Kim YK, Song HC, Choi EJ, Yang CW, Kim YS, Lim PS, Ming Ying W, Ya-Chung J, Zaripova I, Kayukov I, Essaian A, Nimgirova A, Young H, Dungey M, Watson EL, Baines R, Burton JO, Smith AC, Joki N, Iwasaki M, Tanaka Y, Kubo S, Hayashi T, Ikeda N, Yamazaki K, Hase H, Bossola M, Colacicco L, Scribano D, Vulpio C, Tazza L, Okada T, Okada N, Michibata I, Yura T, Montero N, Soler M, Pascual M, Barrios C, Marquez E, Rodriguez E, Orfila MA, Cao H, Arcos E, Comas J, Pascual J, Ferrario M, Garzotto F, Sironi T, Monacizzo S, Basso F, Garzotto F, Cruz DN, Moissl U, Tetta C, Signorini MG, Cerutti S, Ronco C, Mostovaya I, Grooteman M, Van den Dorpel M, Penne L, Van der Weerd N, Mazairac A, Den Hoedt C, Levesque R, Nube M, Ter Wee P, Bots M, Blankestijn P, Liu J, MA KL, Zhang X, Liu BC, Vladu ID, Mustafa R, Cana-Ruiu D, Vaduva C, Grauntanu C, Mota E, Singh R, Abbasian N, Stover C, Brunskill N, Burton J, Abbasian N, Herbert K, Bevington A, Brunskill N, Burton J, Wu M, Tang RN, Gao M, Liu H, Chen L, LV LL, Liu BC, Nikodimopoulou M, Liakos S, Kapoulas S, Karvounis C, Fedak D, Kuzniewski M, Paulina D, Kusnierz-Cabala B, Kapusta M, Solnica B, Sulowicz W, Junque A, Vicent ES, Moreno L, Fulquet M, Duarte V, Saurina A, Pou M, Macias J, Lavado M, Ramirez de Arellano M, Ryuzaki M, Nakamoto H, Kinoshita S, Kobayashi E, Takimoto C, Shishido T, Enia G, Torino C, Tripepi R, Panuccio V, Postorino M, Clementi A, Garozzo M, Bonanno G, Boito R, Natale G, Cicchetti T, Chippari A, Logozzo D, Alati G, Cassani S, Sellaro A, Zoccali C, Quiroga B, Verde E, Abad S, Vega A, Goicoechea M, Reque J, Lopez-Gomez JM, Luno J, Cabre Menendez C, Moles V, Vives JP, Villa D, Vinas J, Compte T, Arruche M, Diaz C, Soler J, Aguilera J, Martinez Vea A, De Mauri A, David P, Conte MM, Chiarinotti D, Ruva CE, De Leo M, Bargnoux AS, Morena M, Jaussent I, Chalabi L, Bories P, Dion JJ, Henri P, Delage M, Dupuy AM, Badiou S, Canaud B, Cristol JP, Fabbrini P, Sironi E, Pieruzzi F, Galbiati E, Vigano MR, Stella A, Genovesi S, Anpalakhan S, Anpalakhan S, Rocha S, Chitalia N, Sharma R, Kaski JC, Chambers J, Goldsmith D, Banerjee D, Cernaro V, Lacquaniti A, Lupica R, Lucisano S, Fazio MR, Donato V, Buemi M, Segalen I, Segalen I, Vinsonneau U, Tanquerel T, Quiniou G, Le Meur Y, Seibert E, Girndt M, Zohles K, Ulrich C, Kluttig A, Nuding S, Swenne C, Kors J, Werdan K, Fiedler R, Van der Weerd NC, Grooteman MP, Bots M, Van den Dorpel MA, Den Hoedt C, Nube MJ, Wetzels J, Swinkels DW, Blankestijn P, Ter Wee PM, Khandekar A, Khandge J, Lee JE, Moon SJ, Choi KH, Lee HY, Kim BS, Morena M, Tuaillon E, Jaussent I, Rodriguez A, Chenine L, Vendrell JP, Cristol JP, Canaud B, Sue YM, Tang CH, Chen YC, Sanchez-Perales C, Vazquez E, Segura P, Garcia Cortes MJ, Gil JM, Biechy MM, Liebana A, Poulikakos D, Shah A, Persson M, Banerjee D, Dattolo P, Amidone M, Amidone M, Michelassi S, Moriconi L, Betti G, Conti P, Rosati A, Mannarino A, Panichi V, Pizzarelli F, Klejna K, Naumnik B, Koc-Zorawska E, Mysliwiec M, Dimitrie S, Simona H, Mihaela O, Mugurel A, Gabriela O, Radu S, Octavian P, Adrian C, Akdam H, Akar H, Yenicerioglu Y, Kucuk O, Kurt Omurlu I, Goldsmith D, Thambiah S, Roplekar R, Manghat P, Manghat P, Fogelman I, Fraser W, Hampson G, Likaj E, Likaj E, Caco G, Seferi S, Rroji M, Barbullushi M, Thereska N, Onofriescu M, Hogas S, Luminita V, Mugurel A, Serban A, Carmen V, Cristian S, Silvia L, Covic A. Cardiovascular complications in CKD 5D. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Meisel M, Nuding S, Müller-Werdan U. [Assessment of elderly intensive care patients]. Med Klin Intensivmed Notfmed 2012; 107:29-31. [PMID: 22349475 DOI: 10.1007/s00063-011-0029-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 12/21/2011] [Indexed: 11/30/2022]
Abstract
The standard geriatric basic assessment validly presents the functional limitations of elderly patients. The prognosis estimation of elderly people is less precise using the instruments for cardiovascular and preoperative risk evaluation or by the intensive care medicine scores on organ failure. An adaptation and further development of score systems could clarify these vague areas.
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Affiliation(s)
- M Meisel
- Klinik für Innere Medizin und Geriatrie, Diakonissenkrankenhaus Dessau gGmbH, Gropiusallee 3, 06846, Dessau-Roßlau, Deutschland.
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Nuding S, Ebelt H, Hoke RS, Krummenerl A, Wienke A, Müller-Werdan U, Werdan K. Reducing elevated heart rate in patients with multiple organ dysfunction syndrome by the I (f) (funny channel current) inhibitor ivabradine : MODI (f)Y trial. Clin Res Cardiol 2011; 100:915-23. [PMID: 21638157 DOI: 10.1007/s00392-011-0323-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 05/12/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND Heart rate (HR) is of relevant prognostic value not only in the general population and patients with cardiovascular disease, but also in critically ill patients with multiple organ dysfunction syndrome (MODS). An elevated HR in MODS patients is associated with a worse prognosis. Beta-blocker (BB) administration has been shown to reduce mortality in MODS. In most cases, negative inotropic effects prevent administration of BBs in MODS patients. In this trial we investigate, whether the "funny current" (I (f)) channel inhibitor ivabradine is able and apt to reduce pathologically elevated HR in MODS patients. We hypothesize that critically ill patients could derive particular benefit from the specific HR-lowering agent ivabradine. METHODS MODI (f)Y is a prospective, single centre, open label, randomized, controlled two arms, phase II-trial to evaluate the potential of ivabradine to reduce an elevated HR in MODS patients. The primary end point is the proportion of patients with a reduction of HR by at least 10 beats per minute (bpm) within 4 days. This trial will randomize 70 patients (men and women, aged ≥18 years) with newly diagnosed MODS, with an elevated HR (sinus rhythm with HR ≥90 bpm) and contraindications to BB therapy. Treatment period will last for 4 days. All patients will be followed for 6 months. RESULTS The first patient was randomized on May 21, 2010. CONCLUSIONS The MODI (f)Y trial is the first application of ivabradine as a pure heart rate reducing agent in MODS patients.
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Affiliation(s)
- Sebastian Nuding
- Department of Medicine III (Cardiology, Angiology, Medical Intensive Care Medicine, Geriatrics, Sports Medicine), University Clinics Halle (Saale),Germany.
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Möndel M, Schroeder BO, Zimmermann K, Huber H, Nuding S, Beisner J, Fellermann K, Stange EF, Wehkamp J. Probiotic E. coli treatment mediates antimicrobial human beta-defensin synthesis and fecal excretion in humans. Mucosal Immunol 2009; 2:166-72. [PMID: 19129752 PMCID: PMC10026704 DOI: 10.1038/mi.2008.77] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [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: 02/04/2023]
Abstract
Inducible epithelial human beta-defensins (hBD) play an important role in intestinal barrier function. In vitro studies showed that clinically effective probiotics induce antimicrobial hBD-2. Here, we aimed to assess the in vivo effect in healthy volunteers and also addressed how defensins affect probiotic survival. Symbioflor 2 containing one strain of several viable genotypes of Escherichia coli was administered to 23 healthy individuals. After 3 weeks, fecal hBD-2 peptide was increased in 78% (mean 3.7-fold; P<0.0001). Interestingly, the fecal hBD-2 peptide was still elevated 9 weeks after treatment (P=0.008). In vitro studies revealed that this effect was mediated by only one out of three tested E. coli genotypes and comparable to probiotic E. coli Nissle 1917 (10- to 15-fold). Functional assays showed that all tested bacteria were similarly killed by defensins allowing to speculate about a suicidal character of this effect. Defensin induction seems to be a common and important mechanism of probiotic treatment.
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Affiliation(s)
- M Möndel
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tübingen, Stuttgart, Germany
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Hennen R, Friedrich I, Hoyer D, Nuding S, Rauchhaus M, Schulze M, Schlisske S, Schwesig R, Schlitt A, Buerke M, Müller-Werdan U, Werdan K, Schmidt H. Autonome Dysfunktion und Betablocker beim Multiorgandysfunktionssyndrom. Dtsch Med Wochenschr 2008; 133:2500-4. [DOI: 10.1055/s-0028-1100944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Heinroth KM, Elster M, Nuding S, Schlegel F, Christoph A, Carter J, Buerke M, Werdan K. Impedance cardiography: a useful and reliable tool in optimization of cardiac resynchronization devices. Europace 2007; 9:744-50. [PMID: 17496288 DOI: 10.1093/europace/eum086] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Optimizing cardiac resynchronization therapy (CRT) devices has become more complex since modification of both atrioventricular (AV) and interventricular (VV) stimulation intervals has become possible. The current paper presents data from the routine use of impedance cardiography (IC)-based cardiac output (CO) measurements to guide the optimization of AV- and VV-interval timing of CRT devices. METHODS AND RESULTS Forty-six patients with heart failure (left ventricular ejection fraction <35%, New York Heart Association (NYHA) III-IV) and left bundle branch block (>130 ms) in sinus rhythm were evaluated 3-5 days after implantation of a CRT device by means of IC. CO was measured without pacing and with biventricular pacing using a standard protocol of VV- and AV-interval modification from -60 to +60 ms and 80 to 140 ms, respectively, in 20 ms steps. Mean CO without pacing was 3.66 +/- 0.85 L/min and significantly increased to 4.40 +/- 1.1 L/min (P<0.05) with simultaneous biventricular pacing and an AV interval of 120 ms. 'Optimizing' both VV and AV intervals further increased CO to 4.86 +/- 1.1 L/min (P<0.05). Maximum CO was measured in most patients with left ventricular pre-excitation. The proportion of 'non-responders' to CRT was reduced by 56% following AV- and VV-interval modification using IC guidance. CONCLUSION Modification of both AV and VV intervals in patients with a CRT device significantly improves CO compared with standard simultaneous biventricular pacing and no pacing. IC is a useful non-invasive technique for guiding this modification. Marked variability of optimal AV and VV intervals between patients requires optimization of these intervals for each patient individually.
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Affiliation(s)
- Konstantin M Heinroth
- Department of Medicine III/Cardiology, Martin-Luther-University Halle-Wittenberg, E, rnst-Grube-Strasse 40, 06097, Halle (Saale), Germany.
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Zabel L, Anliker M, Nuding S, Müller H. P1155 Flow-cytometric assay to detect group B streptococci in vaginal swabs. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nuding S, Zabel L, Fellermann K, Wehkamp J, Mueller H, Stange F. P803 Different antimicrobial activity of beta defensins and colonic biopsy extracts against aerobic and anaerobic bacterial strains of the gastrointestinal tract. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schmidt H, Müller-Werdan U, Nuding S, Hoffmann T, Francis DP, Hoyer D, Rauchhaus M, Werdan K. Impaired chemoreflex sensitivity in adult patients with multiple organ dysfunction syndrome?the potential role of disease severity. Intensive Care Med 2004; 30:665-72. [PMID: 14963644 DOI: 10.1007/s00134-003-2131-2] [Citation(s) in RCA: 30] [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] [Subscribe] [Scholar Register] [Received: 06/18/2002] [Accepted: 11/14/2003] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The cardiac chemoreflex sensitivity is a powerful predictor of autonomic dysfunction in chronic heart failure and after myocardial infarction. The objective of the present study was to characterize cardiac chemoreflex sensitivity in patients with multiple organ dysfunction syndrome (MODS). We also aimed to elucidate the effect of the severity of MODS on the assessment of cardiac chemoreflex sensitivity. DESIGN Prospective cohort study. SETTING Twelve-bed medical intensive care unit in a university center. PATIENTS Forty consecutively admitted patients with MODS during a 7-month period. Patients with MODS were identified by an APACHE II score of 20 or more. Sepsis was defined as a Sepsis Score, according to Elebute and Stoner, of 12 or more. INTERVENTIONS The cardiac chemoreflex sensitivity was assessed using the regression of heart interval (ms) versus arterial oxygen pressure (mmHg). MEASUREMENTS AND RESULTS First, we established a new method to assess cardiac chemoreflex sensitivity and applied it to healthy controls and patients. Second, we found that cardiac chemoreflex sensitivity correlated with the severity of MODS as calculated by the APACHE II score ( r(2)=0.34, p=0.001). This relation was best fitted by a model including minimum heart rate and standard bicarbonate in 24 h ( r(2)=0.5, p<0.001) and Glasgow Coma Scale ( r(2)=0.5, p=0.005). Age, however, did not significantly contribute ( r(2)=0.001, p=0.8). CONCLUSIONS The calculation of cardiac chemoreflex sensitivity enabled us to quantify an important component of the cardiorespiratory interactions in patients with MODS. Severity of illness was a more pronounced determinant of impaired cardiac chemoreflex sensitivity than age. The quantification of the cardiorespiratory interactions by measuring the cardiac chemoreflex sensitivity has potential to identify a subgroup of patients with worse prognosis.
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Affiliation(s)
- Hendrik Schmidt
- University Department of Medicine III, Klinikum Kröllwitz, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle/Saale, Germany.
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Schmidt HB, Rauchhaus M, Francis DP, Davies CL, Nuding S, Peschel T, Schmidt DS, Coats AJ, Opitz H, Werdan K. Assessment of chemoreflex sensitivity in free breathing young subjects by correction for respiratory influence. Int J Cardiol 2001; 78:157-65. [PMID: 11334660 DOI: 10.1016/s0167-5273(01)00377-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 10/27/2022]
Abstract
BACKGROUND The assessment of autonomic function is an important tool for risk stratification in critically ill patients. Peripheral cardiac chemoreflex sensitivity has been considered a marker for increased risk of sudden cardiac death. In normals, the evaluation of peripheral cardiac chemoreflex sensitivity is performed under controlled breathing conditions during inhalation of hypoxic gas. Since this is poorly tolerated by patients, they are commonly studied under hyperoxic conditions, which are not physiological. METHODS We studied 20 healthy volunteers who underwent free and controlled breathing of a hypoxic gas mixture (10% O2 in N2) over 5 min. Values of peripheral cardiac chemoreflex sensitivity, corrected for respiratory influence, were compared with the results obtained experimentally under controlled breathing conditions in the same subjects. RESULTS We found a substantial difference between values obtained during free and controlled breathing (3.64 +/- 0.81 vs. 1.53 +/- 0.32 ms/mmHg, respectively; P < 0.05). After application of a respiratory correction, described and validated in this article, no significant difference was seen for these values (0.89 +/-0.91 vs. 1.53 +/- 0.32 ms/mmHg, P = 0.46). CONCLUSIONS This approach allows the evaluation of peripheral cardiac chemoreflex sensitivity in free breathing subjects. This correction could improve the assessment of cardiac chemoreflex sensitivity in patients with cardiorespiratory disorders, who find it difficult to control their breathing according to an experimental protocol.
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Affiliation(s)
- H B Schmidt
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, 06097, Halle/Saale, Germany.
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