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Hoffmann K, Hainzl A, Stingl M, Kurz K, Biesenbach B, Bammer C, Behrends U, Broxtermann W, Buchmayer F, Cavini AM, Fretz GS, Gole M, Grande B, Grande T, Habermann-Horstmeier L, Hackl V, Hamacher J, Hermisson J, King M, Kohl S, Leiss S, Litzlbauer D, Renz-Polster H, Ries W, Sagelsdorff J, Scheibenbogen C, Schieffer B, Schön L, Schreiner C, Thonhofer K, Strasser M, Weber T, Untersmayr E. [Interdisciplinary, collaborative D-A-CH (Germany, Austria and Switzerland) consensus statement concerning the diagnostic and treatment of myalgic encephalomyelitis/chronic fatigue syndrome]. Wien Klin Wochenschr 2024; 136:103-123. [PMID: 38743348 PMCID: PMC11093804 DOI: 10.1007/s00508-024-02372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe, chronic multisystemic disease which, depending on its severity, can lead to considerable physical and cognitive impairment, loss of ability to work and the need for nursing care including artificial nutrition and, in very severe cases, even death.The aim of this D-A-CH (Germany, Austria, Switzerland) consensus statement is 1) to summarize the current state of knowledge on ME/CFS, 2) to highlight the Canadian Consensus Criteria (CCC) as clinical criteria for diagnostics with a focus on the leading symptom post-exertional malaise (PEM) and 3) to provide an overview of current options and possible future developments, particularly with regard to diagnostics and therapy. The D-A-CH consensus statement is intended to support physicians, therapists and valuer in diagnosing patients with suspected ME/CFS by means of adequate anamnesis and clinical-physical examinations as well as the recommended clinical CCC, using the questionnaires and other examination methods presented. The overview of the two pillars of therapy for ME/CFS, pacing and symptom-relieving therapy options, is intended not only to provide orientation for physicians and therapists, but also to support decision-makers from healthcare policy and insurance companies in determining which therapy options should already be reimbursable by them at this point in time for the indication ME/CFS.
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Affiliation(s)
- Kathryn Hoffmann
- Allgemeinmedizin, Public Health und Versorgungsforschung, Abteilung für Primary Care Medicine, Zentrum für Public Health, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich.
| | - Astrid Hainzl
- Österreichische Gesellschaft für ME/CFS, Wien, Österreich
| | | | - Katharina Kurz
- Innere Medizin, Universitätsklinik für Innere Medizin II, MedUni Innsbruck, Innsbruck, Österreich
| | - Beate Biesenbach
- Kinder- und Jugendheilkunde, kokon - Reha für junge Menschen, Kinder-Reha Rohrbach-Berg GmbH, Rohrbach-Berg, Österreich
| | - Christoph Bammer
- Innere Medizin, Nephrologie & Geriatrie, a. ö. BKH Kufstein, Kufstein, Österreich
| | - Uta Behrends
- MRI Chronische Fatigue Centrum für junge Menschen (MCFC), Zentrum für Kinder- und Jugendmedizin: eine Kooperation des Klinikums rechts der Isar, Technischen Universität München und der München Klinik gGmbH, München, Deutschland
| | | | - Florian Buchmayer
- Psychiatrie und Psychotherapie, Abteilung für Psychiatrie und Psychotherapie, Krankenhaus der Barmherzigen Brüder, Eisenstadt, Österreich
| | - Anna Maria Cavini
- Fachärztin für Kinder- und Jugendheilkunde, Psychotherapeutische Medizin, St.Veit/Glan, Österreich
| | - Gregory Sacha Fretz
- Department Innere Medizin, Medizinische Poliklinik, Kantonsspital Graubünden, Loestraße 170, 7000, Chur, Schweiz
| | - Markus Gole
- Psychologie und Philosophie, Praxis für Psychologie, Philosophie und Berufskunde, Linz, Österreich
| | - Bettina Grande
- Psychotherapie und Psychoanalyse, Heidelberg, Deutschland
| | - Tilman Grande
- Psychotherapie und Psychoanalyse, Heidelberg, Deutschland
| | | | - Verena Hackl
- Physiotherapie, AUVA Rehabilitationszentrum Meidling, Wien, Österreich
| | - Jürg Hamacher
- Innere Medizin und Pneumologie, Lindenhofspital, Bern, Schweiz
| | - Joachim Hermisson
- Biomathematik, Fakultät für Mathematik, Universität Wien, Wien, Österreich
- Department of Structural and Computational Biology, Max Perutz Labs, Wien, Österreich
| | - Martina King
- Lehrstuhl für Medical Humanities, Mathematisch-Naturwissenschaftliche und Medizinische Fakultät, Universität Fribourg, Fribourg, Schweiz
| | - Sonja Kohl
- #MillionsMissing Deutschland, Bedburg-Hau, Deutschland
| | - Sandra Leiss
- Österreichische Gesellschaft für ME/CFS, Wien, Österreich
| | | | - Herbert Renz-Polster
- Kinder- und Jugendheilkunde, Zentrum für Präventivmedizin und Digitale Gesundheit, Abteilung Allgemeinmedizin, Universitätsmedizin Mannheim, Universität Heidelberg, Heidelberg, Deutschland
| | - Wolfgang Ries
- Nephrologie, Dialyse, DIAKO Krankenhaus gGmbH, Flensburg, Deutschland
| | | | - Carmen Scheibenbogen
- Institut für Med. Immunologie, Sektion Immundefekte und Postinfektiöse Erkrankungen, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland
| | - Bernhard Schieffer
- Klinik für Innere Medizin-Kardiologie- Angiologie und Internistische Intensivmedizin und Zentrums für Notfallmedizin, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | - Lena Schön
- Physiotherapie, Physio Austria: Fachgruppe für komplexe Multisystemerkrankungen, Wien, Österreich
| | - Claudia Schreiner
- Österreichische Gesellschaft für ME/CFS, Wien, Österreich
- #MillionsMissing Deutschland, Bedburg-Hau, Deutschland
| | | | - Maja Strasser
- Neurologie, Neurologische Praxis Solothurn, Solothurn, Schweiz
| | - Thomas Weber
- Schmerzmedizin, Facharzt für Anästhesie und Intensivmedizin, Graz, Österreich
| | - Eva Untersmayr
- Klinische Immunologie, Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie, Medizinische Universität Wien, Wien, Österreich
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Markus B, Patsalis N, Müller C, Chatzis G, Möller L, Rupa R, Viniol S, Betz S, Schieffer B, Kreutz J. Early goal-directed management after out-of-hospital cardiac arrest: lessons from a certified cardiac Arrest centre. Eur Heart J Qual Care Clin Outcomes 2024:qcae032. [PMID: 38702842 DOI: 10.1093/ehjqcco/qcae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
BACKGROUND Despite continuous advances in post-resuscitation management, outcome after out-of-hospital cardiac arrest (OHCA) is limited. To improve the outcome, interdisciplinary Cardiac Arrest Centers (CACs) have been established in recent years, but survival remains low and treatment strategies vary considerably in clinical and geographical aspects. Here we analyzed a strategy of in-hospital post-resuscitation management while evaluating the outcome. METHODS A broad spectrum of pre- and in-hospital parameters of 545 resuscitated patients, admitted to the Cardiac Arrest Center of the University Hospital of Marburg (MCAC) between 01/2018 and 12/2022 were retrospectively analyzed. Inclusion criteria were ≥ 18 years, resuscitation by emergency medical services, and non-traumatic cause of OHCA. RESULTS In the overall patient cohort, the survival rate to hospital discharge was 39.8% (n = 217/545), which is 50.7% higher than in the EuReCa-TWO registry. 77.2% of the survivors had CPC status 1 or 2 (favorable neurological outcome) before and after therapy. A standardized 'therapy bundle' for in-hospital post-resuscitation management was applied to 445 patients who survived the initial treatment in the emergency department. In addition to basic care (standardized antimicrobial therapy, adequate anticoagulation, targeted sedation, early enteral and parenteral nutrition), it includes early whole-body CT (n = 391; 87.9%), invasive coronary diagnostics (n = 322; 72.4%), targeted temperature management (n = 293; 65.8%) and if indicated, mechanical circulatory support (n = 145; 32.6%) and appropriate neurological diagnostics. CONCLUSIONS Early goal-directed post-resuscitation management in a well-established and highly frequented CAC leads to significantly higher survival rates. However, our results underline the need for a broader standardization in post-resuscitation management to ultimately improve the outcome.
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Affiliation(s)
- Birgit Markus
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Cardiology, Angiology, and Intensive Care Medicine, Germany
| | - Nikolaos Patsalis
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Cardiology, Angiology, and Intensive Care Medicine, Germany
| | - Charlotte Müller
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Cardiology, Angiology, and Intensive Care Medicine, Germany
| | - Georgios Chatzis
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Cardiology, Angiology, and Intensive Care Medicine, Germany
| | - Leona Möller
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Neurology, Germany
| | - Rosita Rupa
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Neurosurgery, Germany
| | - Simon Viniol
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Radiology, Germany
| | - Susanne Betz
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Center for Emergency Medicine, Germany
| | - Bernhard Schieffer
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Cardiology, Angiology, and Intensive Care Medicine, Germany
- University Hospital of Marburg, Center for Emergency Medicine, Germany
| | - Julian Kreutz
- Philipps University of Marburg, Germany
- University Hospital of Marburg, Department of Cardiology, Angiology, and Intensive Care Medicine, Germany
- University Hospital of Marburg, Center for Emergency Medicine, Germany
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Schmid A, Pankuweit S, Vlacil AK, Koch S, Berge B, Gajawada P, Richter M, Troidl K, Schieffer B, Schäffler A, Grote K. Decreased circulating CTRP3 levels in acute and chronic cardiovascular patients. J Mol Med (Berl) 2024; 102:667-677. [PMID: 38436713 PMCID: PMC11055757 DOI: 10.1007/s00109-024-02426-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
C1q/TNF-related protein 3 (CTRP3) represents an adipokine with various metabolic and immune-regulatory functions. While circulating CTRP3 has been proposed as a potential biomarker for cardiovascular disease (CVD), current data on CTRP3 regarding coronary artery disease (CAD) remains partially contradictory. This study aimed to investigate CTRP3 levels in chronic and acute settings such as chronic coronary syndrome (CCS) and acute coronary syndrome (ACS). A total of 206 patients were classified into three groups: CCS (n = 64), ACS having a first acute event (ACS-1, n = 75), and ACS having a recurrent acute event (ACS-2, n = 67). The control group consisted of 49 healthy individuals. ELISA measurement in peripheral blood revealed decreased CTRP3 levels in all patient groups (p < 0.001) without significant differences between the groups. This effect was exclusively observed in male patients. Females generally exhibited significantly higher CTRP3 plasma levels than males. ROC curve analysis in male patients revealed a valuable predictive potency of plasma CTRP3 in order to identify CAD patients, with a proposed cut-off value of 51.25 ng/mL. The sensitivity and specificity of prediction by CTRP3 were congruent for the subgroups of CCS, ACS-1, and ACS-2 patients. Regulation of circulating CTRP3 levels in murine models of cardiovascular pathophysiology was found to be partly opposite to the clinical findings, with male mice exhibiting higher circulating CTRP3 levels than females. We conclude that circulating CTRP3 levels are decreased in both male CCS and ACS patients. Therefore, CTRP3 might be useful as a biomarker for CAD but not for distinguishing an acute from a chronic setting. KEY MESSAGES: CTRP3 levels were found to be decreased in both male CCS and ACS patients compared to healthy controls. Plasma CTRP3 has a valuable predictive potency in order to identify CAD patients among men and is therefore proposed as a biomarker for CAD but not for distinguishing between acute and chronic settings. Regulation of circulating CTRP3 levels in murine models of cardiovascular pathophysiology was found to be partly opposite to the clinical findings in men.
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Affiliation(s)
- Andreas Schmid
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany.
| | - Sabine Pankuweit
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | | | - Sören Koch
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Benedikt Berge
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Praveen Gajawada
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Kerstin Troidl
- Department of Life Sciences and Engineering, TH Bingen, University of Applied Sciences, Bingen Am Rhein, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | | | - Andreas Schäffler
- Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Karsten Grote
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
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Grote K, Schaefer AC, Soufi M, Ruppert V, Linne U, Mukund Bhagwat A, Szymanski W, Graumann J, Gercke Y, Aldudak S, Hilfiker-Kleiner D, Schieffer E, Schieffer B. Targeting the High-Density Lipoprotein Proteome for the Treatment of Post-Acute Sequelae of SARS-CoV-2. Int J Mol Sci 2024; 25:4522. [PMID: 38674105 PMCID: PMC11049911 DOI: 10.3390/ijms25084522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Here, we target the high-density lipoprotein (HDL) proteome in a case series of 16 patients with post-COVID-19 symptoms treated with HMG-Co-A reductase inhibitors (statin) plus angiotensin II type 1 receptor blockers (ARBs) for 6 weeks. Patients suffering from persistent symptoms (post-acute sequelae) after serologically confirmed SARS-CoV-2 infection (post-COVID-19 syndrome, PCS, n = 8) or following SARS-CoV-2 vaccination (PVS, n = 8) were included. Asymptomatic subjects with corresponding serological findings served as healthy controls (n = 8/8). HDL was isolated using dextran sulfate precipitation and the HDL proteome of all study participants was analyzed quantitatively by mass spectrometry. Clinical symptoms were assessed using questionnaires before and after therapy. The inflammatory potential of the patients' HDL proteome was addressed in human endothelial cells. The HDL proteome of patients with PCS and PVS showed no significant differences; however, compared to controls, the HDL from PVS/PCS patients displayed significant alterations involving hemoglobin, cytoskeletal proteins (MYL6, TLN1, PARVB, TPM4, FLNA), and amyloid precursor protein. Gene Ontology Biological Process (GOBP) enrichment analysis identified hemostasis, peptidase, and lipoprotein regulation pathways to be involved. Treatment of PVS/PCS patients with statins plus ARBs improved the patients' clinical symptoms. After therapy, three proteins were significantly increased (FAM3C, AT6AP2, ADAM10; FDR < 0.05) in the HDL proteome from patients with PVS/PCS. Exposure of human endothelial cells with the HDL proteome from treated PVS/PCS patients revealed reduced inflammatory cytokine and adhesion molecule expression. Thus, HDL proteome analysis from PVS/PCS patients enables a deeper insight into the underlying disease mechanisms, pointing to significant involvement in metabolic and signaling disturbances. Treatment with statins plus ARBs improved clinical symptoms and reduced the inflammatory potential of the HDL proteome. These observations may guide future therapeutic strategies for PVS/PCS patients.
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Affiliation(s)
- Karsten Grote
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
| | - Ann-Christin Schaefer
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
| | - Muhidien Soufi
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
| | - Volker Ruppert
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
| | - Uwe Linne
- Mass Spectrometry Facility, Department of Chemistry, Philipps University Marburg, 35043 Marburg, Germany;
| | - Aditya Mukund Bhagwat
- Institute of Translational Proteomics & Core Facility Translational Proteomics, Philipps University Marburg, 35043 Marburg, Germany (W.S.)
| | - Witold Szymanski
- Institute of Translational Proteomics & Core Facility Translational Proteomics, Philipps University Marburg, 35043 Marburg, Germany (W.S.)
| | - Johannes Graumann
- Institute of Translational Proteomics & Core Facility Translational Proteomics, Philipps University Marburg, 35043 Marburg, Germany (W.S.)
| | - Yana Gercke
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
| | - Sümeya Aldudak
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
| | - Denise Hilfiker-Kleiner
- Institute Cardiovascular Complications in Pregnancy and Oncologic Therapies, Philipps University Marburg, 35043 Marburg, Germany;
| | - Elisabeth Schieffer
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (K.G.); (A.-C.S.); (M.S.); (V.R.); (S.A.); (E.S.)
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Patsalis N, Kreutz J, Chatzis G, Fichera CF, Syntila S, Choukeir M, Griewing S, Schieffer B, Markus B. Discussion of hemodynamic optimization strategies and the canonical understanding of hemodynamics during biventricular mechanical support in cardiogenic shock: does the flow balance make the difference? Clin Res Cardiol 2024; 113:602-611. [PMID: 38261027 PMCID: PMC10954998 DOI: 10.1007/s00392-024-02377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Mechanical circulatory support (MCS) devices may stabilize patients with severe cardiogenic shock (CS) following myocardial infarction (MI). However, the canonical understanding of hemodynamics related to the determination of the native cardiac output (CO) does not explain or support the understanding of combined left and right MCS. To ensure the most optimal therapy control, the current principles of hemodynamic measurements during biventricular support should be re-evaluated. METHODS Here we report a protocol of hemodynamic optimization strategy during biventricular MCS (VA-ECMO and left ventricular Impella) in a case series of 10 consecutive patients with severe cardiogenic shock complicating myocardial infarction. During the protocol, the flow rates of both devices were switched in opposing directions (+ / - 0.7 l/min) for specified times. To address the limitations of existing hemodynamic measurement strategies during biventricular support, different measurement techniques (thermodilution, Fick principle, mixed venous oxygen saturation) were performed by pulmonary artery catheterization. Additionally, Doppler ultrasound was performed to determine the renal resistive index (RRI) as an indicator of renal perfusion. RESULTS The comparison between condition 1 (ECMO flow > Impella flow) and condition 2 (Impella flow > VA-ECMO flow) revealed significant changes in hemodynamics. In detail, compared to condition 1, condition 2 results in a significant increase in cardiac output (3.86 ± 1.11 vs. 5.44 ± 1.13 l/min, p = 0.005) and cardiac index (2.04 ± 0.64 vs. 2.85 ± 0.69, p = 0.013), and mixed venous oxygen saturation (56.44 ± 6.97% vs. 62.02 ± 5.64% p = 0.049), whereas systemic vascular resistance decreased from 1618 ± 337 to 1086 ± 306 s*cm-5 (p = 0.002). Similarly, RRI decreased in condition 2 (0.662 ± 0.05 vs. 0.578 ± 0.06, p = 0.003). CONCLUSIONS To monitor and optimize MCS in CS, PA catheterization for hemodynamic measurement is applicable. Higher Impella flow is superior to higher VA-ECMO flow resulting in a more profound increase in CO with subsequent improvement of organ perfusion.
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Affiliation(s)
- Nikolaos Patsalis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Giorgos Chatzis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Carlo-Federico Fichera
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Styliani Syntila
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Maryana Choukeir
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Sebastian Griewing
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of the Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany.
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6
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Markus B, Kreutz J, Chatzis G, Syntila S, Choukeir M, Schieffer B, Patsalis N. Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock. J Clin Med 2024; 13:1265. [PMID: 38592106 PMCID: PMC10931749 DOI: 10.3390/jcm13051265] [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: 01/30/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of mechanical circulatory support like the Impella on RV function are rare. Here, we investigated the effects of the left ventricular (LV) Impella on RV function. Moreover, we aimed to identify the most optimal and the earliest applicable parameter for bedside monitoring of RV function by comparing the predictive abilities of three common RV function parameters: the pulmonary artery pulsatility index (PAPi), the ratio of right atrial pressure to pulmonary capillary wedge pressure (RA/PCWP), and the right ventricular stroke work index (RVSWI). Methods: The data of 50 patients with CS complicating myocardial infarction, supported with different flow levels of LV Impella, were retrospectively analyzed. Results: Enhancing Impella flow (1.5 to 2.5 L/min ± 0.4 L/min) did not lead to a significant variation in PAPi (p = 0.717), RA/PCWP (p = 0.601), or RVSWI (p = 0.608), indicating no additional burden for the RV. PAPi revealed the best ability to connect RV function with global hemodynamic parameters, i.e., cardiac index (CI; p < 0.001, 95% CI: 0.181-0.663), pulmonary capillary wedge pressure (PCWP; p = 0.005, 95% CI: -6.721--1.26), central venous pressure (CVP; p < 0.001, 95% CI: -7.89-5.575), and indicators of tissue perfusion (central venous oxygen saturation (SvO2); p = 0.008, 95% CI: 1.096-7.196). Conclusions: LV Impella does not impair RV function. Moreover, PAPi seems to be to the most effective and valid predictor for early bedside monitoring of RV function.
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Affiliation(s)
- Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Giorgios Chatzis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Styliani Syntila
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Maryana Choukeir
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Nikolaos Patsalis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
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7
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Cheko J, Patsalis N, Kreutz J, Divchev D, Chatzis G, Schieffer B, Markus B. The Impact of Positive Inotropic Therapy on Hemodynamics and Organ Function in Acute Heart Failure: A Differentiated View. J Pers Med 2023; 14:17. [PMID: 38248718 PMCID: PMC10820131 DOI: 10.3390/jpm14010017] [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: 11/17/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Little is known about the impact of treatment with inotropic drugs on the interaction of hemodynamics, biomarkers, and end-organ function in patients with acute decompensated heart failure (HF) of different origins and heart rhythms. METHODS Fifty patients with different causes of acute decompensated HF (dilated cardiomyopathy DCM, ischemic cardiomyopathy ICM, atrial fibrillation AF, sinus rhythm/pacemaker lead rhythm SR/PM) were treated with dobutamine or levosimendan. Non-invasive hemodynamics, biomarkers, and parameters of renal organ function were evaluated at hospital admission and after myocardial recompensation (day 5 to 7). RESULTS Twenty-seven patients with ICM and twenty-three patients with DCM were included. Thirty-nine patients were treated with dobutamine and eleven with levosimendan. Sixteen were accompanied by persistent AF and thirty-four presented either with SR or PM. In the overall cohort, body weight and biomarkers (NT-proBNP/ST2) significantly decreased. GFR significantly increased during therapy with either dobutamine or levosimendan. However, hemodynamic parameters seem to be only improved in patients with DCM, in the levosimendan sub-group, and in patients with SR/PM. CONCLUSION Patients with acute decompensated HF benefit from positive inotropic therapy during short-term follow-ups. In particular, patients with DCM, those after levosimendan therapy and those with SR/PM, seem to benefit most from inotropic therapy.
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Affiliation(s)
| | | | | | | | | | | | - Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, Hospital of the Phillips University of Marburg, D-35043 Marburg, Germany; (J.C.); (N.P.); (J.K.); (D.D.); (G.C.); (B.S.)
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8
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Ausbuettel F, Barth S, Chatzis G, Fischer D, Kerber S, Mueller J, List S, Halbfass P, Deneke T, Nef H, Mueller HH, Divchev D, Schieffer B, Luesebrink U, Waechter C. Catheter ablation of concomitant atrial fibrillation improves survival of patients undergoing transcatheter edge-to-edge mitral valve repair. Front Cardiovasc Med 2023; 10:1229651. [PMID: 37645518 PMCID: PMC10461005 DOI: 10.3389/fcvm.2023.1229651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common concomitant disease in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) and detrimentally affects their outcome. While there is increasing evidence for prognostic improvement and safety of catheter ablation (CA) of AF in the overall cohort of heart failure patients, corresponding data in TEER patients are lacking. Objectives To investigate the impact of treatment regimens for concomitant AF on survival of TEER patients. Methods In a multicenter observational cohort study consecutive patients successfully undergoing TEER were analyzed and survival of patients receiving CA of concomitant AF was compared with that of patients on pharmacological AF treatment and with that of patients without a history of AF, using propensity score matching (PSM). Results A total of 821 patients were analyzed. Of these, 608 (74.1%) had concomitant AF, of whom 48 patients received CA. Patients with CA in AF showed significantly higher 3-year-survival after TEER compared to PSM-patients on pharmacological AF treatment (75.5% [36/48] vs. 49.4% [166/336], p = 0.009). The 3-year-survival after TEER of patients with concomitant AF treated with CA was not significantly different from PSM-patients without AF (75.5% [36/48] vs. 68.3% [98/144], p = 0.36). Conclusions CA of AF is superior to pharmacotherapy as it significantly improves the survival of TEER patients in a PSM analysis. CA even offsets the prognostic disadvantage of coexisting AF in TEER patients. Given the growing evidence of prognostic benefits in the overall cohort of HF patients, our data point out the importance of treating concomitant AF and support CA as an essential part of a holistic management of TEER patients.
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Affiliation(s)
- Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Stephan List
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Philipp Halbfass
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
- Department of Cardiology, University Hospital Gießen, Justus Liebig University Gießen, Gießen, Germany
| | - Hans-Helge Mueller
- Institute for Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Waechter
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
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9
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Waechter C, Fehse L, Welzel M, Heider D, Babalija L, Cheko J, Mueller J, Pöling J, Braun T, Pankuweit S, Weihe E, Kinscherf R, Schieffer B, Luesebrink U, Soufi M, Ruppert V. Comparative analysis of full-length 16s ribosomal RNA genome sequencing in human fecal samples using primer sets with different degrees of degeneracy. Front Genet 2023; 14:1213829. [PMID: 37564874 PMCID: PMC10411958 DOI: 10.3389/fgene.2023.1213829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Next-generation sequencing has revolutionized the field of microbiology research and greatly expanded our knowledge of complex bacterial communities. Nanopore sequencing provides distinct advantages, combining cost-effectiveness, ease of use, high throughput, and high taxonomic resolution through its ability to process long amplicons, such as the entire 16s rRNA genome. We examine the performance of the conventional 27F primer (27F-I) included in the 16S Barcoding Kit distributed by Oxford Nanopore Technologies (ONT) and that of a more degenerate 27F primer (27F-II) in the context of highly complex bacterial communities in 73 human fecal samples. The results show striking differences in both taxonomic diversity and relative abundance of a substantial number of taxa between the two primer sets. Primer 27F-I reveals a significantly lower biodiversity and, for example, at the taxonomic level of the phyla, a dominance of Firmicutes and Proteobacteria as determined by relative abundances, as well as an unusually high ratio of Firmicutes/Bacteriodetes when compared to the more degenerate primer set (27F-II). Considering the findings in the context of the gut microbiomes common in Western industrial societies, as reported in the American Gut Project, the more degenerate primer set (27F-II) reflects the composition and diversity of the fecal microbiome significantly better than the 27F-I primer. This study provides a fundamentally relevant comparative analysis of the in situ performance of two primer sets designed for sequencing of the entire 16s rRNA genome and suggests that the more degenerate primer set (27F-II) should be preferred for nanopore sequencing-based analyses of the human fecal microbiome.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Leon Fehse
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Marius Welzel
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Lek Babalija
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Juan Cheko
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Jochen Pöling
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Thomas Braun
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Sabine Pankuweit
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Eberhard Weihe
- Institute of Anatomy and Cell Biology, Medical Faculty, Philipps University Marburg, Marburg, Germany
| | - Ralf Kinscherf
- Institute of Anatomy and Cell Biology, Medical Faculty, Philipps University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Muhidien Soufi
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Center for Undiagnosed and Rare Diseases, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Volker Ruppert
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Center for Undiagnosed and Rare Diseases, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
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10
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Schieffer E, Schieffer B. Corrigendum: The rationale for the treatment of long-COVID esymptoms-a cardiologist's view. Front Cardiovasc Med 2023; 10:1244340. [PMID: 37547250 PMCID: PMC10402735 DOI: 10.3389/fcvm.2023.1244340] [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: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2022.992686.].
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11
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Waechter C, Koenig AM, Chatzis G, Mueller J, Schieffer B, Luesebrink U. Delayed perforation of an atrial pacemaker electrode: Lifelong risk for a rare but serious complication. Clin Case Rep 2023; 11:e7525. [PMID: 37327138 PMCID: PMC10268212 DOI: 10.1002/ccr3.7525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Abstract
Key Clinical Message Nonspecific symptoms such as pleuritic or pericardial chest pain in cardiovascular implantable electronic devices patients, even with unremarkable ECG or device parameters, should always raise suspicion of electrode perforation, regardless of how long ago the implantation was performed. Abstract We report the successful percutaneous management of a 77-year-old woman who had a dual-chamber pacemaker implanted more than 1 year ago and presented with pericarditis pain and compensated pericardial hemorrhagic tamponade. The symptoms were due to very late acute perforation of the atrial lead. This report is intended to raise awareness of procedure-related complications in the large group of cardiovascular implantable electronic device patients. Pleuritic or pericardial pain in these patients should raise suspicion of electrode perforation, as the risk of perforation is not restricted to the period immediately after implantation and a lifelong risk cannot apparently be excluded.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Alexander M. Koenig
- Clinic of Diagnostic and Interventional Radiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Julian Mueller
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital MarburgPhilipps University MarburgMarburgGermany
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12
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Parahuleva MS, Harbaum L, Patsalis N, Parahuleva N, Arndt C, Lüsebrink U, Schieffer B, Kreutz J. New-Onset Atrial Fibrillation in the Setting of COVID-19 Infection Is a Predictor of Mortality in Hospitalized Patients: CovAF-Study. J Clin Med 2023; 12:jcm12103500. [PMID: 37240606 DOI: 10.3390/jcm12103500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Recent studies show that hospitalized COVID-19 patients have an increased incidence of arrhythmia, especially atrial fibrillation (AF). This single-center study included 383 hospitalized patients with positive polymerase chain reaction tests for COVID-19 from March 2020 to April 2021. Patient characteristics were documented, and data were analyzed for episodes of AF on admission or during the hospital stay, intrahospital mortality, need for intensive care and/or invasive ventilation, inflammatory parameters (hs-CRP, IL-6, and procalcitonin), and differential blood count. We demonstrated that in the setting of hospitalized cases of COVID-19 infection, there is an incidence of 9.8% (n = 36) for the occurrence of new-onset AF. Furthermore, it was shown that a total of 21% (n = 77) had a history of episodes of paroxysmal/persistent AF. However, only about one-third of patients with pre-existing AF had relevant documented tachycardic episodes during the hospital stay. Patients with new-onset AF had a significantly increased intrahospital mortality compared to the control and the pre-existing AF without rapid ventricular rate (RVR) group. Patients with new-onset AF required intensive care and invasive ventilation more frequently. Further analysis examined patients with episodes of RVR and demonstrated that they had significantly elevated CRP (p < 0.05) and PCT (p < 0.05) levels on the day of hospital admission compared to patients without RVR.
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Affiliation(s)
- Mariana S Parahuleva
- Department of Cardiology, Angiology and Intensive Care Medicine, Philipps University of Marburg, 35043 Marburg, Germany
| | - Lukas Harbaum
- Department of Cardiology, Angiology and Intensive Care Medicine, Philipps University of Marburg, 35043 Marburg, Germany
| | - Nikolaos Patsalis
- Department of Cardiology, Angiology and Intensive Care Medicine, Philipps University of Marburg, 35043 Marburg, Germany
| | - Nikoleta Parahuleva
- Department of Obstetrics and Gynecology, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Christian Arndt
- Department of Anesthesia and Intensive Care Medicine, Philipps University of Marburg, 35043 Marburg, Germany
| | - Ulrich Lüsebrink
- Department of Cardiology, Angiology and Intensive Care Medicine, Philipps University of Marburg, 35043 Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Intensive Care Medicine, Philipps University of Marburg, 35043 Marburg, Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology and Intensive Care Medicine, Philipps University of Marburg, 35043 Marburg, Germany
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13
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Kreutz J, Heitmann J, Schäfer AC, Aldudak S, Schieffer B, Schieffer E. Environmental factors and their impact on the COVID-19 pandemic. Herz 2023:10.1007/s00059-023-05178-2. [PMID: 37097475 PMCID: PMC10127158 DOI: 10.1007/s00059-023-05178-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous cases of illness and death worldwide. Research has shown that there are associations between transmission, as well as the severity of SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) infections, and various environmental factors. For example, air pollution with particulate matter is thought to play a crucial role, and both climatic and geographical aspects must be considered. Furthermore, environmental conditions such as industry and urban lifestyle have a significant impact on air quality and thus on health aspects of the population. In this regard, other factors such as chemicals, microplastics, and diet also critically impact health, including respiratory and cardiovascular diseases. Overall, the COVID-19 pandemic has highlighted how closely health and the environment are linked. This review discusses the impact of environmental factors on the COVID-19 pandemic.
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Affiliation(s)
- Julian Kreutz
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany.
| | - Juliane Heitmann
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Ann-Christin Schäfer
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Sümeya Aldudak
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Elisabeth Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
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14
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Heitmann J, Kreutz J, Aldudak S, Schieffer E, Schieffer B, Schäfer AC. A practical approach for the treatment of post-COVID symptoms. Herz 2023:10.1007/s00059-023-05177-3. [PMID: 37087708 PMCID: PMC10122758 DOI: 10.1007/s00059-023-05177-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 04/24/2023]
Abstract
For the past 3 years, our daily lives have been largely dictated by the coronavirus disease 2019 (COVID-19) pandemic. In many people, this infectious disease leads to long-lasting symptoms, which can vary greatly in form and intensity between individuals. This report describes the case of a young patient who had no health restrictions until she came into contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As part of a post-COVID syndrome, she not only temporarily lost her ability to work, but was also no longer able to manage her daily life independently. A crucial therapeutic approach, in this case, was the use of heparin-induced extracorporeal LDL/fibrinogen precipitation (H.E.L.P.) apheresis.
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Affiliation(s)
- Juliane Heitmann
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Sümeya Aldudak
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Elisabeth Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Ann-Christin Schäfer
- Department of Cardiology, Angiology, and Intensive Care Medicine, Philipps University of Marburg, Baldinger Str., 35043, Marburg, Germany.
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Hatzis GD, Markus B, Luesebrink U, Karatolios K, Schieffer B, Syntila S. COMPARISON OF MECHANICAL SUPPORT WITH IMPELLA OR EXTRACORPOREAL LIFE SUPPORT IN POST-CARDIAC ARREST CARDIOGENIC SHOCK: A PROPENSITY SCORING MATCHING ANALYSIS, ON BEHALF OF MARPELLA INVESTIGATORS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01132-4] [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: 03/06/2023]
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Kreutz J, Choukeir M, Chatzis G, Schieffer B, Markus B. Hemoadsorption as part of a multimodal therapy concept to treat Capnocytophaga sepsis with thrombocytopenia and multiple organ failure. Int J Artif Organs 2023; 46:52-57. [PMID: 36401351 DOI: 10.1177/03913988221132575] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Capnocytophaga, a bacteria native to the oral flora of canines, in rare cases can lead to severe infections resulting in septic shock, respiratory tract infection, and multiple organ failure. In case of trauma following animal bites with rapidly progressing clinical courses, also adjunctive therapeutic measures such as extracorporeal blood purification therapies might be beneficial. CASE PRESENTATION We report on a 68-year-old male who was hospitalized with fever, oliguria and repeated vomiting after suffering a minor bite by his dog. On admission, he was diagnosed with sepsis. In addition, his coagulation status was markedly deranged resulting in the administration of mass transfusions to stabilize his coagulative status. Following detection of Capnocytophaga canimorsus, anti-infective therapy was initiated. In the context of a progressive respiratory deterioration and an increasing vigilance disorder, he had to be intubated. Due to development of renal failure, dialysis was started in conjunction with CytoSorb hemoadsorption therapy to control the hyperinflammatory condition. All of the applied therapeutic measures led to a rapid clinical stabilization, a control of the hyperinflammatory situation, and an improvement in his neurological status. The therapy was well tolerated with no complications encountered. CONCLUSIONS This case supports the clinical recognition of severe Capnocytophaga infection that can lead to critical conditions even in immunocompetent patients. Combined broad spectrum antibiotic therapy, mass transfusions, CRRT, and CytoSorb hemoadsorption therapy resulted in a control of the critical situation. However, further research is needed to fully elucidate the role of hemoadsorption in this rare but life-threatening setting.
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Affiliation(s)
- Julian Kreutz
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital (UKGM) Marburg, Philipps University, Marburg, Germany
| | - Maryana Choukeir
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital (UKGM) Marburg, Philipps University, Marburg, Germany
| | - Georgios Chatzis
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital (UKGM) Marburg, Philipps University, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital (UKGM) Marburg, Philipps University, Marburg, Germany
| | - Birgit Markus
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital (UKGM) Marburg, Philipps University, Marburg, Germany
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Waechter C, Ausbuettel F, Chatzis G, Cheko J, Fischer D, Nef H, Barth S, Halbfass P, Deneke T, Mueller J, Kerber S, Divchev D, Schieffer B, Luesebrink U. Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients. J Cardiovasc Dev Dis 2022; 9:366. [PMID: 36354765 PMCID: PMC9695441 DOI: 10.3390/jcdd9110366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 08/31/2023] Open
Abstract
Transcatheter edge-to-edge mitral valve repair (TEER) has become established as a safe and efficacious therapy for severe mitral regurgitation (MR) in high-risk patients. Despite its widespread use, postprocedural antithrombotic therapy (ATT) still to date is based on local expertise rather than evidence. In a multicenter, observational cohort study, 646 consecutive patients undergoing TEER were enrolled; 609 patients were successfully treated and antithrombotic therapy analyzed; 449 patients (73.7%) were previously treated with oral anticoagulants (OAC) due to the high prevalence of atrial fibrillation (459/609, 75.4%). Postprocedural ATT in patients previously treated with OAC consisted of no additional, additional single (SAPT) or dual antiplatelet therapy (DAPT) in 146/449 (33.6%), 248/449 (55.2%) and 55/449 (12.2%), respectively. There were 234/449 (52.1%) patients treated with vitamin-k antagonists (VKA) and 215/449 (47.9%) with nonvitamin-k antagonist oral anticoagulants (NOAC). One hundred sixty patients (26.3%) had no prior indication for OAC and were predominantly treated with DAPT (132/160, 82.5%). Use of SAPT (17/160, 10.6%) and no APT (11/160, 6.9%) was marginal. No statistically significant differences in terms of in-hospital mortality or the rate of major adverse cardiac and cerebrovascular events (MACCE) between the different antithrombotic therapy regimens were observed. Multiple Cox regression analysis showed a statistically significant decreased risk for all-cause mortality after a median follow-up of 419 days for OAC monotherapy (HR 0.6, 95%-CI 0.5-0.9, p = 0.04). This study provides evidence for a more favorable long-term outcome of OAC monotherapy in patients with an indication for OAC and reiterates the urgent need for randomized controlled trials on the optimal antithrombotic treatment of TEER patients.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Juan Cheko
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg an der Fulda, Germany
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg an der Fulda, Germany
- Department of Cardiology, University Hospital Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Philipp Halbfass
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
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18
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Chatzis G, Markus B, Ahrens H, Luesebrink U, Karatolios K, Schuett H, Patsalis N, Divchev D, Schieffer B, Syntila S. Comparison of mechanical support with Impella or extracorporeal life support in post-cardiac arrest cardiogenic shock: a propensity scoring matching analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Out of hospital cardiac arrest (OHCA) is a major public health problem and a leading cause of death in industrialized nations. Post-cardiac arrest cardiogenic shock (CS) occurs frequently after resuscitation from CA and may lead to multi-organ failure and death, even in patients with good neurologic prognosis. Mechanical circulatory support (MCS) may be considered at that time in order to augment cardiac output, stabilize hemodynamics and ensure adequate organ perfusion. However, optimal selection of the device type remains unclear and, so far, no specific guideline recommendation exists. The Impella pump and extracorporeal circulatory support (ECLS) are the most frequently used device types for temporary percutaneous MCS in this context.
Purpose
Our aim was to compare outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI).
Methods
Reetrospective study of patients resuscitated from OHCA with post-cardiac arrest CS following AMI (May 2015 to May 2020) treated with MCS in terms of Impella or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups of MCS.
Results
159 patients were included (Impella, n=105; ECLS, n=54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS group (p=0.16 and p=0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p=0.36 and p=0.64, respectively) (Figure 1). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 hours (p<0.01 vs p=0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p<0.01 for relevant access site bleeding, 7.6% versus 20.4%, p=0.04 for limb ischemia requiring intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate <8,6 mmol/L, time from collapse to return of spontaneous circulation <28 min, vasoactive score <46 and Horowitz index >182) (Figure 2).
Conclusions
In the biggest so far homogenous study of OHCA, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients, while it was associated with a better survival in patients with low risk profile after OHCA. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Chatzis
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - B Markus
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - H Ahrens
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - U Luesebrink
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - K Karatolios
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - H Schuett
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - N Patsalis
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - D Divchev
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - B Schieffer
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
| | - S Syntila
- Philipps University of Marburg, Cardiology, Angiology, Internal Medicine and Intensive Care Unit, Cardiac Arrest Marburg , Marburg , Germany
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19
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Schubart JM, Schaefer MKH, Bonaterra GA, Mey L, Luesebrink U, Schieffer B, Eiden LE, Kinscherf R, Weihe E, Waechter C. Deficiency of pituitary adenylate cyclase-activating peptide and its receptor PAC1 confers interstitial cardiac fibrosis in a murine model of metabolic stress. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Fibrosis is a hallmark of cardiac remodeling and is present in a variety of cardiac diseases. In particular, in the highly prevalent heterogeneous group of cardiac dysfunctions with preserved left ventricular ejection fraction (LVEF), interstitial fibrosis has been identified as a pivotal pathophysiological factor. Current evidence suggests that comorbidities, mainly from the metabolic spectrum, promote chronic systemic low-grade inflammation with secondary affection of the heart, leading to fibrosis and thus impairing cardiac structure and function. In contrast to cardiac dysfunction with reduced LVEF, which is predominantly of ischemic origin, effective antifibrotic treatment options are very limited emphasizing the urgent need for new therapeutic targets. In this context, the recent report of an antifibrotic effect of the pleiotropic neuropeptide pituitary adenylate cyclase-activating peptide (PACAP) in irradiation-induced myocardial damage [1] renders it an intriguing new candidate.
Purpose
The aim of this study is to elucidate the role of PACAP and of PAC1 receptor in cardiac fibrosis in a murine model of metabolic stress.
Methods
PACAP−/− and PAC1−/− C57/Bl6 J mice were crossbred with an ApoE−/− strain and metabolic stress was induced by feeding a cholesterol-enriched diet (CED) for 10 weeks. Standard chow (SD) served as control diet. Tissue samples of the ventricles were processed for FFPE histological analysis with hematoxylin/eosin, Giemsa and picrosirius red stains and subjected to morphometric quantification of cardiomyocyte cross diameters and fibrosis using a software-based image analysis approach.
Results
After 10 weeks of CED, a statistically significant higher extent of myocardial fibrosis was detected in PACAP−/−/ApoE−/− and PAC1−/−/ApoE−/− compared to ApoE−/− mice (Fig. 1). The pattern of fibrous deposition was consistent with that of reactive interstitial fibrosis and affected both ventricles uniformly. Morphometric analysis revealed no macroscopic or cellular hypertrophy in the PACAP−/−/ApoE−/− and PAC1−/−/ApoE−/− mice compared with ApoE−/− mice after CED. All morphological changes were exclusively present after feeding CED and were not detectable with SD feeding.
Conclusions
This study provides novel evidence for a significant involvement of PACAP and its receptor PAC1 in the development of metabolically induced cardiac fibrosis. The antifibrotic effect of PACAP, which can be inferred in this context, is mediated to a significant extent via the PAC1 receptor, and only becomes apparent under metabolic stress conditions. The absence of macroscopic and cellular cardiac hypertrophy in PACAP deficient or PAC1 deficient mice as demonstrated here precludes relevant hemodynamic effects of PACAP and PAC1 receptor, respectively. According to the results of our pilot study, PACAP analogues or PAC1 receptor agonists may offer a therapeutic potential to attenuate metabolically triggered cardiac fibrosis.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This research was partly supported by the Von Behring-Röntgen-Stiftung Schloss 1 D-35037 Marburg, Germany.
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Affiliation(s)
- J M Schubart
- Philipps University of Marburg, Department of Medical Cell Biology , Marburg , Germany
| | - M K H Schaefer
- Center for Mind, Brain and Behavior (CMBB) , Marburg , Germany
| | - G A Bonaterra
- Philipps University of Marburg, Department of Medical Cell Biology , Marburg , Germany
| | - L Mey
- Philipps University of Marburg, Department of Medical Cell Biology , Marburg , Germany
| | - U Luesebrink
- University Hospital Giessen and Marburg, Department of Cardiology , Marburg , Germany
| | - B Schieffer
- University Hospital Giessen and Marburg, Department of Cardiology , Marburg , Germany
| | - L E Eiden
- National Institutes of Health, Laboratory of Cellular and Molecular Regulation , Bethesda , United States of America
| | - R Kinscherf
- Philipps University of Marburg, Department of Medical Cell Biology , Marburg , Germany
| | - E Weihe
- Center for Mind, Brain and Behavior (CMBB) , Marburg , Germany
| | - C Waechter
- University Hospital Giessen and Marburg, Department of Cardiology , Marburg , Germany
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20
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Chatzis G, Markus B, Ahrens H, Luesebrink U, Divchev D, Schuett H, Karatolios K, Schieffer B, Syntila S. The MARPELLA risk score for prediction of mortality in all-cause refractory cardiogenic shock treated with microaxial transvalvular pump: the MARPELLA study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although Impella may serve as an alternative strategy in order to stabilize the heart function without the detrimental effects of catecholamines or to bridge the patients in definite therapies in the setting of cardiogenic shock (CS), leading to a widespread use of this device, data concerning reliable prediction or predefining which patients would benefit from the implantation of such a device are completely lacking.
Purpose
To evaluate and to compare the prognostic accuracy of the Acute-Physiology-And-Chronic-Health II (APACHE II), the Simplified-Acute-Physiology-Score II (SAPS II), the Sepsis-related-organ-failure-assessment (SOFA), the intra-aortic-balloon-pump (IABP), the CardShock Score in refractory CS treated with Impella 2.5/CP. Moreover, we aimed to assess the prediction-of-Cardiogenic-shock-Outcome-foR-AMI-patients-salvaGed by VA-ECMO (ENCOURAGE) and the Survival-after -Veno-Arterial-extracorporeal-membranoxygenation (VA-ECMO) (SAVE) score, though initially for VA-ECMO patients created, in patients with CS as well as to develop a new prognostic score in this setting.
Methods
Single center study of consecutive Impella patients with CS admitted to Cardiology department of our university, from February 2013 until December 2020.
Results
A total of 401 patients were included in the analysis. 31% of the patients were supported with Impella CP, whereas 153 (38,1%) patients were resuscitated prior admission. Causes of CS was acute myocardial infarction in 311 (77,5%) patients, followed by dilatative cardiomyopathy/myocarditis (11,1%) and aortic stenosis (6%). The expected mortality according to scores was: SOFA 50%, SAPS II 70%, IABP Shock 55%, CardShock 60%, APACHE II 65%, ENCOURAGE 75% and SAVE score 70%. We observed a survival of 48,9% on hospital discharge and 45,6% after 12 months follow-up. Among the traditional scores estimated, the ENCOURAGE score was the most effective predictive model of mortality outcome presenting a moderate area under curve (AUC) of 0.72, followed by the CardShock, which derived an AUC of 0,7. The SAPS II, SOFA, IABP and the SAVE scores failed to predict outcome in this setting. According to the main predictors of outcome in our population derived from univariate analysis (vasoactive score >31, lactate>4,7 mmol/l, pH<7,31, Creatinine>1,33 mg/dl, Horowitz Index<238, age>71 years and prior resuscitation) as well as the odds ratio derived from binary regression analysis on mortality, a new score, the MARPELLA score, was created. This score reached an AUC of 0.83 (Figure 1). A mortality of 37%, 62% and 83,2% was observed in the low-, intermediate and high-risk group of the MARPELLA score, respectively (Figure 2).
Conclusion
MARPELLA Score is a new more potent score in the setting of all-cause CS that may guide clinicians to optimize the therapy in this group of patients, outweighing the traditional CS and intensive care unit scores.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Chatzis
- Philipps University of Marburg , Marburg , Germany
| | - B Markus
- Philipps University of Marburg , Marburg , Germany
| | - H Ahrens
- Philipps University of Marburg , Marburg , Germany
| | - U Luesebrink
- Philipps University of Marburg , Marburg , Germany
| | - D Divchev
- Philipps University of Marburg , Marburg , Germany
| | - H Schuett
- Philipps University of Marburg , Marburg , Germany
| | - K Karatolios
- Philipps University of Marburg , Marburg , Germany
| | - B Schieffer
- Philipps University of Marburg , Marburg , Germany
| | - S Syntila
- Philipps University of Marburg , Marburg , Germany
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21
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Syntila S, Markus B, Ahrens H, Luesebrink U, Waechter C, Karatolios K, Divchev D, Sassani K, Schieffer B, Chatzis G. Biventricular unloading with impella and venoarterial extracorporeal membrane oxygenation in severe refractory cardiogenic shock: prognosis and implications from the combined use of the devices. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with refractory cardiogenic shock (RCS) may present with left ventricle (LV)-failure, biventricular failure or even combined cardiopulmonary failure. Mechanical support with Impella or veno-arterial membrane oxygenation (VA-ECMO) have emerged as an alternative strategy in order to stabilize the heart function without the detrimental effects of catecholamines or to bridge the patients in definite therapies. However, the selection of the appropriate MCS should be tailored according to the underlying pathophysiology and properties of the respective MCS device. Patients with Impella who initially presented with univentricular LV failure may develop additionally right ventricle (RV) dysfunction or pulmonary failure whereas patients with VA-ECMO may show signs of LV overloading, causing pulmonary edema, LV distension and thus compromising LV myocardial recovery.
Purpose
To present the main outcomes and predictors of survival and safety in RCS treated with Impella and VA-ECMO.
Methods
Single center study of consecutive patients with biventricular unloading with Impella and VA-ECMO for RCS admitted to Cardiology department of Philipps University in Marburg, Germany, from February 2013 until December 2019. The selection of the device was based on a standard algorithm (Figure 1).
Results
A total of 67 patients was included in the study. Mean age was 61.07±10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. In 28 patients Impella was implanted first, whereas VA-ECMO was the first MCS device in 39 patients. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54±16.03 and 12.25±2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p<0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate >6 mmol/L, vasoactive score >100 and pH <7.26 on initiation of biventricular support, as well as Charlson comorbity index (CCI) >3 and prior resuscitation were independent predictors of survival (Figure 2).
Conclusions
Biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels. Lactate, pH and vasoactive score on initiation of biventricular support, as well as age-adjusted CCI and prior resuscitation are independent risk factors associated with mortality in this group of patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Syntila
- Philipps University of Marburg , Marburg , Germany
| | - B Markus
- Philipps University of Marburg , Marburg , Germany
| | - H Ahrens
- Philipps University of Marburg , Marburg , Germany
| | - U Luesebrink
- Philipps University of Marburg , Marburg , Germany
| | - C Waechter
- Philipps University of Marburg , Marburg , Germany
| | - K Karatolios
- Philipps University of Marburg , Marburg , Germany
| | - D Divchev
- Philipps University of Marburg , Marburg , Germany
| | - K Sassani
- Philipps University of Marburg , Marburg , Germany
| | - B Schieffer
- Philipps University of Marburg , Marburg , Germany
| | - G Chatzis
- Philipps University of Marburg , Marburg , Germany
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22
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Griewing S, Gremke N, Kreutz J, Schieffer B, Timmermann L, Markus B. Chronological Development of Cardiovascular Disease in Times of COVID-19: A Retrospective Analysis of Hospitalized Diseases of the Circulatory System and COVID-19 Patients of a German University Hospital. J Cardiovasc Dev Dis 2022; 9:jcdd9100325. [PMID: 36286277 PMCID: PMC9604270 DOI: 10.3390/jcdd9100325] [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: 08/30/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims at examining the chronological development of hospitalized cardiovascular and COVID-19 patients and comparing the effects on related sub-disciplines and main diagnoses for pre-pandemic (2017–2019) and pandemic (2020–2021) years in the setting of a German university maximum care provider. Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with main diagnosis of diseases of the circulatory system (nCirculatory) and COVID-19 secondary diagnosis (nCOVID-19). The cardiovascular patient collective (nCirculatory = 25,157) depicts a steady state in terms of relative yearly development of patient numbers (+0.4%, 2019–2020, +0.1%, 2020–2021). Chronological assessment points towards monthly decline during lockdowns and phases of high regional incidence of COVID-19 (i.e., 2019–2020: March −10.2%, April −12.4%, December −14.8%). Main diagnoses of congestive heart failure (+16.1% 2019/2020; +19.2% 2019/2021) and acute myocardial infarction show an increase in case numbers over the course of the whole pandemic (+15.4% 2019/2020; +9.4% 2019/2021). The results confirm negative effects on the cardiovascular care situation during the entire pandemic in the setting of a university maximum care provider. A general increase in cardiac disorders and a worrisome turn in case development of acute myocardial infarction emphasize the feared cardiovascular burden of COVID-19.
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Affiliation(s)
- Sebastian Griewing
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
- Institute for Health Care Management, General Business Administration, Philipps-University Marburg, Universitätsstraße 24, 35037 Marburg, Hessen, Germany
- Correspondence: ; Tel.: +49-172-6823779
| | - Niklas Gremke
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Julian Kreutz
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Bernhard Schieffer
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Lars Timmermann
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
| | - Birgit Markus
- University Hospital Marburg, Philipps-University Marburg, 35043 Marburg, Hessen, Germany
- Institute for Health Care Management, General Business Administration, Philipps-University Marburg, Universitätsstraße 24, 35037 Marburg, Hessen, Germany
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23
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Schieffer E, Schieffer B. The rationale for the treatment of long-Covid symptoms – A cardiologist's view. Front Cardiovasc Med 2022; 9:992686. [PMID: 36186977 PMCID: PMC9520195 DOI: 10.3389/fcvm.2022.992686] [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: 07/12/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
The ongoing coronavirus disease 2019 pandemic left us with thousands of patients suffering from neurological, cardiovascular, and psychiatric disorders named post-acute sequelae of COVID-19 or just long-Covid. In parallel, the vaccination campaigns against SARS-CoV-2 spike protein saved millions of lives worldwide but long-Covid symptoms also appeared rarely following vaccination with a strong overlap to the “canonical” long-Covid symptoms. A therapeutic strategy targeting both, post-VAC and post-SARS-CoV-2 long-Covid symptoms is warranted since exposure to the S-protein either by vaccination or SARS-CoV-2 infection may trigger identical immuno-inflammatory cascades resulting in long-Covid symptoms.
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24
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Vlacil AK, Trippel N, Bänfer S, Jacob R, Schieffer B, Grote K. Microplastic particles induce endothelial activation. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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25
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Schulte DM, Waetzig GH, Schuett H, Marx M, Schulte B, Garbers C, Lokau J, Vlacil AK, Schulz J, Seoudy AK, Schieffer B, Rosenstiel P, Seeger M, Laudes M, Rose-John S, Lützen U, Grote K, Schreiber S. Case Report: Arterial Wall Inflammation in Atherosclerotic Cardiovascular Disease is Reduced by Olamkicept (sgp130Fc). Front Pharmacol 2022; 13:758233. [PMID: 35754497 PMCID: PMC9218605 DOI: 10.3389/fphar.2022.758233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Inflammation is a strong driver of atherosclerotic cardiovascular disease (ASCVD). There is a large unmet need for therapies that prevent or reduce excessive inflammation while avoiding systemic immunosuppression. We showed previously that selective inhibition of pro-inflammatory interleukin-6 (IL-6) trans-signalling by the fusion protein olamkicept (sgp130Fc) prevented and reduced experimental murine atherosclerosis in low-density lipoprotein receptor-deficient (Ldlr−/−) mice on a high-fat, high-cholesterol diet independently of low-density lipoprotein (LDL) cholesterol metabolism. Therefore, we allowed compassionate use of olamkicept (600 mg intravenously biweekly for 10 weeks) in a patient with very-high-risk ASCVD. Despite optimal LDL cholesterol under maximum tolerated lipid-lowering treatment, the patient had a remaining very high risk for future cardiovascular events related to significant arterial wall inflammation with lipoprotein (a) [Lp(a)]-cholesterol as the main contributor. 18Fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) measurements were performed before and after the treatment period. Olamkicept reduced arterial wall inflammation in this patient without interfering with lipoprotein metabolism. No clinical or laboratory side effects were observed during or after treatment with olamkicept. Our findings in this patient matched the results from our mechanistic study in Ldlr−/− mice, which were extended by additional analyses on vascular inflammation. Olamkicept may be a promising option for treating ASCVD independently of LDL cholesterol metabolism. A Phase II trial of olamkicept in ASCVD is currently being prepared.
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Affiliation(s)
- Dominik M Schulte
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Institute of Diabetes and Clinical Metabolic Research, Kiel University and UKSH, Kiel, Germany
| | - Georg H Waetzig
- Institute of Clinical Molecular Biology, Kiel University and UKSH, Kiel, Germany.,CONARIS Research Institute AG, Kiel, Germany
| | - Harald Schuett
- Department of Cardiology and Angiology, Philipps-University, Marburg, Germany
| | - Marlies Marx
- Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, UKSH, Kiel, Germany
| | - Berenice Schulte
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Christoph Garbers
- Department of Pathology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Juliane Lokau
- Department of Pathology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ann-Kathrin Vlacil
- Department of Cardiology and Angiology, Philipps-University, Marburg, Germany
| | - Juliane Schulz
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Anna K Seoudy
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Bernhard Schieffer
- Department of Cardiology and Angiology, Philipps-University, Marburg, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Kiel University and UKSH, Kiel, Germany
| | - Marcus Seeger
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Matthias Laudes
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Institute of Diabetes and Clinical Metabolic Research, Kiel University and UKSH, Kiel, Germany
| | | | - Ulf Lützen
- Department of Nuclear Medicine, Molecular Imaging Diagnostics and Therapy, UKSH, Kiel, Germany
| | - Karsten Grote
- Department of Cardiology and Angiology, Philipps-University, Marburg, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany.,Institute of Clinical Molecular Biology, Kiel University and UKSH, Kiel, Germany
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26
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Divchev D, Schnurbus M, Schieffer B. [What's new in pericardial disease?]. Dtsch Med Wochenschr 2022; 147:704-710. [PMID: 35636422 DOI: 10.1055/a-1593-9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pericardial disease represents a large diversity of inflammation related injury of the pericardium. Multifactorial causes may contribute to acute and recurrent pericarditis, pericardial effusion without major hemodynamic compromise, cardiac tamponade or constrictive pericarditis. Currently, inflammatory pericardial pathologies are observed in cases of SARS-CoV-2-infection or after vaccination. Beside established anti-inflammatory therapeutic strategies with NSAID, corticosteroids and colchicine, auto-inflammation and inflammasomes seam to offer more specific targets for advanced treatment options.
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Affiliation(s)
- Dimitar Divchev
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
| | - Mareike Schnurbus
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
| | - Bernhard Schieffer
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
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Jauch-Speer SL, Herrera-Rivero M, Ludwig N, Véras De Carvalho BC, Martens L, Wolf J, Imam Chasan A, Witten A, Markus B, Schieffer B, Vogl T, Rossaint J, Stoll M, Roth J, Fehler O. C/EBPδ-induced epigenetic changes control the dynamic gene transcription of S100a8 and S100a9. eLife 2022; 11:75594. [PMID: 35543413 PMCID: PMC9122501 DOI: 10.7554/elife.75594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
The proinflammatory alarmins S100A8 and S100A9 are among the most abundant proteins in neutrophils and monocytes but are completely silenced after differentiation to macrophages. The molecular mechanisms of the extraordinarily dynamic transcriptional regulation of S100a8 and S100a9 genes, however, are only barely understood. Using an unbiased genome-wide CRISPR/Cas9 knockout (KO)-based screening approach in immortalized murine monocytes, we identified the transcription factor C/EBPδ as a central regulator of S100a8 and S100a9 expression. We showed that S100A8/A9 expression and thereby neutrophil recruitment and cytokine release were decreased in C/EBPδ KO mice in a mouse model of acute lung inflammation. S100a8 and S100a9 expression was further controlled by the C/EBPδ antagonists ATF3 and FBXW7. We confirmed the clinical relevance of this regulatory network in subpopulations of human monocytes in a clinical cohort of cardiovascular patients. Moreover, we identified specific C/EBPδ-binding sites within S100a8 and S100a9 promoter regions, and demonstrated that C/EBPδ-dependent JMJD3-mediated demethylation of H3K27me3 is indispensable for their expression. Overall, our work uncovered C/EBPδ as a novel regulator of S100a8 and S100a9 expression. Therefore, C/EBPδ represents a promising target for modulation of inflammatory conditions that are characterized by S100a8 and S100a9 overexpression.
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Affiliation(s)
| | | | - Nadine Ludwig
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | - Leonie Martens
- Institute of Immunology, University of Münster, Münster, Germany
| | - Jonas Wolf
- Institute of Immunology, University of Münster, Münster, Germany
| | | | - Anika Witten
- Department of Genetic Epidemiology, University of Münster, Münster, Germany
| | - Birgit Markus
- Clinic for Cardiology, Angiology and Internal Intensive Medicine, University Hospital Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Clinic for Cardiology, Angiology and Internal Intensive Medicine, University Hospital Marburg, Marburg, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Monika Stoll
- Department of Genetic Epidemiology, University of Münster, Münster, Germany
| | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
| | - Olesja Fehler
- Institute of Immunology, University of Münster, Münster, Germany
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Grote K, Nicolai M, Schubert U, Schieffer B, Troidl C, Preissner KT, Bauer S, Fischer S. Extracellular Ribosomal RNA Acts Synergistically with Toll-like Receptor 2 Agonists to Promote Inflammation. Cells 2022; 11:cells11091440. [PMID: 35563745 PMCID: PMC9103112 DOI: 10.3390/cells11091440] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Self-extracellular RNA (eRNA), which is released under pathological conditions from damaged tissue, has recently been identified as a new alarmin and synergistic agent together with toll-like receptor (TLR)2 ligands to induce proinflammatory activities of immune cells. In this study, a detailed investigation of these interactions is reported. The macrophage cell line J774 A.1 or C57 BL/6 J wild-type mice were treated with 18S rRNA and different TLR2 agonists. Gene and protein expression of tumor necrosis factor (Tnf)-α; interleukin (Il)-1β, Il-6; or monocyte chemoattractant protein (Mcp)-1 were analyzed and furthermore in vitro binding studies to TLR2 were performed. The TLR2/TLR6-agonist Pam2 CSK4 (Pam2) together with 18S rRNA significantly increased the mRNA expression of inflammatory genes and the release of TNF-α from macrophages in a TLR2- and nuclear factor kappa B (NF-κB)-dependent manner. The injection of 18S rRNA/Pam2 into mice increased the cytokine levels of TNF-α, IL-6, and MCP-1 in the peritoneal lavage. Mechanistically, 18S rRNA built complexes with Pam2 and thus enhanced the affinity of Pam2 to TLR2. These results indicate that the alarmin eRNA, mainly consisting of rRNA, sensitizes TLR2 to enhance the innate immune response under pathological conditions. Thus, rRNA might serve as a new target for the treatments of bacterial and viral infections.
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Affiliation(s)
- Karsten Grote
- Cardiology & Angiology, Medical School, Philipps-University, 35043 Marburg, Germany; (K.G.); (B.S.)
| | - Marina Nicolai
- Institute of Immunology, Medical School, Philipps-University, 35043 Marburg, Germany; (M.N.); (S.B.)
| | - Uwe Schubert
- Institute of Biochemistry, Medical School, Justus-Liebig-University, 35392 Giessen, Germany;
| | - Bernhard Schieffer
- Cardiology & Angiology, Medical School, Philipps-University, 35043 Marburg, Germany; (K.G.); (B.S.)
| | - Christian Troidl
- Medical Clinic I, Cardiology/Angiology, Campus Kerckhoff, Justus-Liebig-University, 61231 Bad Nauheim, Germany;
- Department Cardiology, Kerckhoff-Heart Research Institute, Medical School, Justus-Liebig-University, 35392 Giessen, Germany;
| | - Klaus T. Preissner
- Department Cardiology, Kerckhoff-Heart Research Institute, Medical School, Justus-Liebig-University, 35392 Giessen, Germany;
| | - Stefan Bauer
- Institute of Immunology, Medical School, Philipps-University, 35043 Marburg, Germany; (M.N.); (S.B.)
| | - Silvia Fischer
- Institute of Biochemistry, Medical School, Justus-Liebig-University, 35392 Giessen, Germany;
- Department Cardiology, Kerckhoff-Heart Research Institute, Medical School, Justus-Liebig-University, 35392 Giessen, Germany;
- Correspondence:
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29
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Kreutz J, Mardini A, Schäfer AC, Schieffer B, Markus B. Management of a severe abdominal compartment complicating fulminant cardiogenic-septic shock: An abdominal arterio-venous single-tube ECMO bypass saved a young patient's life after OHCA. Perfusion 2022; 38:876-880. [PMID: 35400212 PMCID: PMC10102912 DOI: 10.1177/02676591221087545] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In severe cardiogenic shock, for example, following cardiac arrest, the implantation of an extracorporeal hemodynamic assist device often seems to be the last option to save a patient's life. However, even though our guidelines provide a class-IIa-recommendation to implant a veno-arterial extracorporeal membrane oxygenation (vaECMO) device in these patients, the accompanying disease- and device-associated complications and their consequences remain challenging to handle. CASE PRESENTATION A 43-year-old patient presented with severe cardiogenic-septic shock with a complicating abdominal compartment due to a prolonged out-of-hospital cardiac arrest (OHCA). A loss of function of the vaECMO, implanted immediately after admission, impended due to increasing intra-abdominal pressure. This dangerous situation was resolved by crafting an experimental "arterio-venous shunt," using the side port of the reinfusion (arterial) vaECMO cannula and a downstream large-volume central access in the right femoral vein toward the abdominal venous system, which led to the patient's full recovery. CONCLUSION In patients with cardiogenic shock, the use of catecholamines and implantation of extracorporeal assist devices alone do not ensure successful therapy. To optimize the outcome, device- and disease-associated complications must also be managed in a timely and minimally invasive procedure.
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Affiliation(s)
- Julian Kreutz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital (UKGM) Marburg, Marburg, Germany
| | - Amar Mardini
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital (UKGM) Marburg, Marburg, Germany
| | - Ann-Christin Schäfer
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital (UKGM) Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital (UKGM) Marburg, Marburg, Germany
| | - Birgit Markus
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital (UKGM) Marburg, Marburg, Germany
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30
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Griewing S, Wagner U, Lingenfelder M, Heinis S, Schieffer B, Markus B. Impact of the COVID-19 Pandemic on Delivery of Gynecology and Obstetrics Services at a Maximum Care University Hospital in Germany. Geburtshilfe Frauenheilkd 2022; 82:427-440. [PMID: 35392066 PMCID: PMC8983110 DOI: 10.1055/a-1687-9674] [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: 05/18/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
Einleitung
Die COVID-19-Pandemie bedeutet einschneidende Maßnahmen für das nationale Gesundheitssystem. Dies bot den Anlass, die klinischen und ökonomischen Leistungsindikatoren der
gynäkologischen und geburtshilflichen Versorgung des Universitätsklinikums Marburg als regionaler universitärer Maximalversorger zu analysieren. Hierzu wurden die Auswirkungen auf die
monatlichen stationären und ambulanten Fallzahlvolumina sowie die entsprechenden ICD- und DRG-Kodierungen ausgewertet, um etwaige Versorgungsdefizite aufzudecken.
Material und Methoden
Die Studie basiert auf einer retrospektiven Datenanalyse therapierter stationären und ambulanten Fälle der Jahre 2016 bis 2020. Hierzu wurden über das
klinikinterne Leistungscontrolling-Programm QlikView die Daten von 9487 Fällen der Klinik für Gynäkologie und 19597 Fällen der Klinik für Geburtshilfe ausgewertet.
Ergebnisse
Es bildet sich eine der nationalen Pandemiedynamik folgende Abnahme der gynäkologischen stationären Fallzahlen um –6% ab, während das geburtshilfliche Fallzahlvolumen um
+11% im Jahr 2020 steigt. Insgesamt fallen die Effekte für die ambulante Versorgung geringer aus. Zudem lässt sich eine standortbezogene Abnahme der C50 „Bösartige Neubildungen der
Brustdrüse“ und C56 „Bösartige Ovarialtumoren“ Diagnosen um –7,4% bzw. –14% feststellen. Eine Rückkehr zu dem Leistungsniveau des Vorjahres konnte im ambulanten in 3 und im stationären
Sektor in 5 Monaten erreicht werden.
Schlussfolgerung
Die negativen Auswirkungen der COVID-19-Pandemie treffen vorwiegend die Klinik für Gynäkologie. Durch das Vertrauen in die Sicherheit der universitären Versorgung
und das Serviceangebot, werdende Väter nach Schnelltestung am Geburtsprozess teilhaben zu lassen, konnte eine Fallzunahme in der Geburtshilfe erreicht werden. Die Rückkehr zu präpandemischen
Leistungsniveaus gestaltet sich weiterhin schleppend, während sich der ohnehin weniger betroffene ambulante Sektor zügiger erholt. Der standortbezogene Rückgang der Diagnosen C50 und C56 ist
besorgniserregend und bedarf epidemiologischer Aufarbeitung. Die fallzahlbezogenen Auswirkungen der Pandemie bilden sich gleichsam in den ökonomischen Leistungskennzahlen ab.
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Affiliation(s)
- Sebastian Griewing
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Marburg UKGM, Philipps-Universität Marburg, Marburg, Germany.,Institut für Health Care Management e.V., Lehrstuhl für Allgemeine Betriebswirtschaftslehre, Philipps-Universität Marburg, Marburg, Germany
| | - Uwe Wagner
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Marburg UKGM, Philipps-Universität Marburg, Marburg, Germany
| | - Michael Lingenfelder
- Institut für Health Care Management e.V., Lehrstuhl für Allgemeine Betriebswirtschaftslehre, Philipps-Universität Marburg, Marburg, Germany
| | - Sylvia Heinis
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Marburg UKGM, Philipps-Universität Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Marburg UKGM, Philipps-Universität Marburg, Marburg, Germany
| | - Birgit Markus
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Marburg UKGM, Philipps-Universität Marburg, Marburg, Germany.,Institut für Health Care Management e.V., Lehrstuhl für Allgemeine Betriebswirtschaftslehre, Philipps-Universität Marburg, Marburg, Germany
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31
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Witten A, Martens L, Schäfer AC, Troidl C, Pankuweit S, Vlacil AK, Oberoi R, Schieffer B, Grote K, Stoll M, Markus B. Monocyte subpopulation profiling indicates CDK6-derived cell differentiation and identifies subpopulation-specific miRNA expression sets in acute and stable coronary artery disease. Sci Rep 2022; 12:5589. [PMID: 35379829 PMCID: PMC8979987 DOI: 10.1038/s41598-022-08600-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/09/2022] [Indexed: 12/20/2022] Open
Abstract
Coronary artery disease (CAD) is a long-lasting inflammatory disease characterized by monocyte migration into the vessel wall leading to clinical events like myocardial infarction (MI). However, the role of monocyte subsets, especially their miRNA-driven differentiation in this scenario is still in its infancy. Here, we characterized monocyte subsets in controls and disease phenotypes of CAD and MI patients using flow cytometry and miRNA and mRNA expression profiling using RNA sequencing. We observed major differences in the miRNA profiles between the classical (CD14++CD16−) and nonclassical (CD14+CD16++) monocyte subsets irrespective of the disease phenotype suggesting the Cyclin-dependent Kinase 6 (CDK6) to be an important player in monocyte maturation. Between control and MI patients, we found a set of miRNAs to be differentially expressed in the nonclassical monocytes and targeting CCND2 (Cyclin D2) that is able to enhance myocardial repair. Interestingly, miRNAs as miR-125b playing a role in vascular calcification were differentially expressed in the classical subset in patients suffering from CAD and not MI in comparison to control samples. In conclusion, our study describes specific peculiarities of monocyte subset miRNA expression in control and diseased samples and provides basis to further functional analysis and to identify new cardiovascular disease treatment targets.
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Soufi M, Bedenbender S, Ruppert V, Kurt B, Schieffer B, Schaefer JR. Fast and Easy Nanopore Sequencing Workflow for Rapid Genetic Testing of Familial Hypercholesterolemia. Front Genet 2022; 13:836231. [PMID: 35222550 PMCID: PMC8864071 DOI: 10.3389/fgene.2022.836231] [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: 12/15/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant lipid metabolism disorder characterized by severely elevated plasma low-density lipoprotein cholesterol levels. The disease is caused by mutations in 3 genes (LDLR, APOB and PCSK9) while over 90% of the mutations are located within the LDLR gene. Thus, genetic analysis of the LDLR gene is the first step in the genetic diagnosis of FH. However, conventional methods like Sanger and NextGen sequencing are still costly and time-consuming. In contrast, Oxford Nanopore technology sequencing is an emerging third-generation sequencing technology featured by easy operability, low cost, small size and the capability of parallel sample sequencing. Here, we present an easy Nanopore-sequencing-based workflow for the rapid genetic testing of FH taking only 3 days and costing less than $50 per sample without the requirement for deep bioinformatic knowledge. Using our workflow, we were able to identify the underlying pathogenic variants of 10 FH patients including one novel, not yet recorded pathogenic variants. Our workflow allows the rapid evaluation of the pathogenic variants by utilizing detailed variant information from Ensembl. Additionally, our workflow is not restricted to sequencing the LDLR gene alone but can be easily adapted to the other FH-causing genes and more importantly, to any desired gene contributing to any hereditary disease. Therefore, our workflow is an attractive opportunity for every diagnostic laboratory to offer fast and easy in-house genetic diagnostics.
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Affiliation(s)
- Muhidien Soufi
- Center for Undiagnosed and Rare Diseases, University Hospital Giessen and Marburg and Philipps University Marburg, Marburg, Germany
- *Correspondence: Muhidien Soufi,
| | - Simon Bedenbender
- Center for Undiagnosed and Rare Diseases, University Hospital Giessen and Marburg and Philipps University Marburg, Marburg, Germany
| | - Volker Ruppert
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Giessen and Marburg and Philipps University Marburg, Marburg, Germany
| | - Bilgen Kurt
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Giessen and Marburg and Philipps University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Giessen and Marburg and Philipps University Marburg, Marburg, Germany
| | - Juergen R. Schaefer
- Center for Undiagnosed and Rare Diseases, University Hospital Giessen and Marburg and Philipps University Marburg, Marburg, Germany
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Schieffer B, Kreutz J, Markus B, Schäfer AC. [Acute Coronary Syndrome (ACS) in Preclinical Emergency Medicine]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:734-745. [PMID: 34820812 DOI: 10.1055/a-1330-5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute coronary syndrome (ACS) is a common diagnosis in preclinical emergency medicine. The term summarizes the acute manifestations of coronary artery disease. It ranges from unstable angina pectoris via cardiogenic shock to sudden cardiac death. The leading key symptom is chest pain. With this trigger symptom, a clinical diagnostic algorithm is initiated, acting quickly on the suspected diagnosis of acute myocardial infarction. Due to the potentially life-threatening course, rapid diagnosis and initiation of therapeutic measures is crucial. Pre-clinical antithrombotic medication and therapy for accompanying symptoms are paramount. As part of the initial assessment, important differential diagnoses should be considered and, within the first 10 minutes after medical contact, an ECG diagnosis should differentiate between ACS with and without ST segment elevations. If ACS is diagnosed, acetylsalicylic acid should be given to inhibit platelet aggregation. The benefits outweigh the very low risk of unnecessary administration. Patients with ACS should be taken to hospital immediately for coronary interventions (PCI). In the case of an ACS with ST segment elevations, reperfusion therapy should be carried out within 120 minutes. In the case of an ACS without ST segment elevations, the time limit (2 - 72 h) until reperfusion is based on the risk stratification. In the majority of cases, the coronary stenosis causing the infarction can be treated with PCI. However, invasive diagnostics show no significant stenosis in a significant proportion of patients with myocardial infarction (prevalence 1 - 14%). This is known as "myocardial infarction with non-obstructive coronary arteries" (MINOCA) and further differential diagnosis should be initiated in these patients.
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Melms L, Falk E, Schieffer B, Jerrentrup A, Wagner U, Matrood S, Schaefer JR, Müller T, Hirsch M. Towards a COVID-19 symptom triad: The importance of symptom constellations in the SARS-CoV-2 pandemic. PLoS One 2021; 16:e0258649. [PMID: 34807925 PMCID: PMC8608328 DOI: 10.1371/journal.pone.0258649] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/02/2021] [Indexed: 12/24/2022] Open
Abstract
Pandemic scenarios like SARS-Cov-2 require rapid information aggregation. In the age of eHealth and data-driven medicine, publicly available symptom tracking tools offer efficient and scalable means of collecting and analyzing large amounts of data. As a result, information gains can be communicated to front-line providers. We have developed such an application in less than a month and reached more than 500 thousand users within 48 hours. The dataset contains information on basic epidemiological parameters, symptoms, risk factors and details on previous exposure to a COVID-19 patient. Exploratory Data Analysis revealed different symptoms reported by users with confirmed contacts vs. no confirmed contacts. The symptom combination of anosmia, cough and fatigue was the most important feature to differentiate the groups, while single symptoms such as anosmia, cough or fatigue alone were not sufficient. A linear regression model from the literature using the same symptom combination as features was applied on all data. Predictions matched the regional distribution of confirmed cases closely across Germany, while also indicating that the number of cases in northern federal states might be higher than officially reported. In conclusion, we report that symptom combinations anosmia, fatigue and cough are most likely to indicate an acute SARS-CoV-2 infection.
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Affiliation(s)
- Leander Melms
- Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
| | - Evelyn Falk
- Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Cardiology Department, University Hospital Gießen and Marburg, Marburg, Germany
| | - Andreas Jerrentrup
- Emergency Department, University Hospital Gießen and Marburg, Marburg, Germany
- Centre for Undiagnosed and Rare Diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Uwe Wagner
- Department of Gynaecology, University Hospital Gießen and Marburg, Marburg, Germany
| | - Sami Matrood
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps-University, Marburg, Germany
| | - Jürgen R. Schaefer
- Centre for Undiagnosed and Rare Diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Tobias Müller
- Centre for Undiagnosed and Rare Diseases, University Hospital Gießen and Marburg, Marburg, Germany
| | - Martin Hirsch
- Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
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35
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Waechter C, Ausbuettel F, Chatzis G, Cheko J, Fischer D, Nef H, Barth S, Halbfass P, Deneke T, Kerber S, Kikec J, Mueller HH, Divchev D, Schieffer B, Luesebrink U. Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair. J Clin Med 2021; 10:5044. [PMID: 34768567 PMCID: PMC8584691 DOI: 10.3390/jcm10215044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growing cohort of patients is unknown. In a multicenter, observational cohort study, 542 consecutive patients undergoing TMVR were enrolled, and subsequently, comprehensive survival analyses according to AF status and therapy were performed using propensity score matching and Cox regression. In the analyzed cohort, 373 (73.3%) of the TMVR patients had concomitant AF. Of these patients, 212 (59%) were on rate control therapy and 161 (41%) were on rhythm control therapy. At 3 years, significantly reduced cumulative survival was observed for patients on rhythm compared to patients on rate control (46.7% (75/161) vs. 56.5% (91/161), p = 0.032). Amiodarone was used to a substantial extent for rhythm control and found to be an independent mortality predictor (Hazard Ratio 1.5, 95%CI 1.1-2.1, p = 0.04). The adverse outcome of concomitant AF in TMVR patients was confirmed (AF: 47.3% (126/266) vs. non-AF: 58.3% (78/133), p = 0.047). Rhythm control achieved almost exclusively pharmacologically is associated with an adverse outcome compared to the rate control of AF in TMVR. This raises awareness of the importance of AF and its treatment, as this seems to be a promising key point for improving the prognosis of TMVR patients.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Juan Cheko
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg/Fulda, Germany; (D.F.); (H.N.)
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg/Fulda, Germany; (D.F.); (H.N.)
- Department of Cardiology, University Hospital Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Philipp Halbfass
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Jan Kikec
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Hans-Helge Mueller
- Institute for Bioinformatics and Biostatistics, Philipps University, Bunsenstraße 3, 35037 Marburg, Germany;
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
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Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Consequences of infection prevention measures during such contagion events can cause disadvantages especially for patients in out-of-hospital cardiac arrest (OHCA). METHODS Retrospective analysis of OHCAs in one county from January-May in 2018, 2019 and 2020, with the first appearance of the SARS-CoV‑2 pandemic in 2020 and a high incidence of the influenza virus in 2018. RESULTS A total of 497 OHCAs were investigated (2018 n = 173; 2019 n = 149; 2020 n = 175). In this study, a constant resuscitation incidence (85-99 resuscitations/100,000 population/year) and locally typical patients (mean 70 years, 66% male; median PES 3) were found. There were no statistically significant differences in the initial situation of the patients (number of observed OHCAs, frequency of lay resuscitations, suspected causes of OHCAs, initial ECG rhythm) and the treatment course (frequency of return of spontaneous circulation [ROSC]/hospital admission/survival to hospital discharge, neurological outcome). None of the OHCA patients in 2020 tested positive for SARS-CoV‑2 and 3 patients in 2018 tested positive for the influenza virus. DISCUSSION The lockdown during the first wave of SARS-CoV‑2 pandemic does not seem to have affected the outcome of OHCA patients without coronavirus disease 2019 (COVID-19) in the end.
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Affiliation(s)
- T. Grübl
- Zentrum für Notfallmedizin, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrzentralkrankenhaus, Rübenacher Straße 170, 56072 Koblenz, Deutschland
| | - B. Plöger
- Zentrum für Notfallmedizin, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland
| | - M. C. Sassen
- Zentrum für Notfallmedizin, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland
- Fachbereich Gefahrenabwehr, Landkreis Marburg-Biedenkopf, Im Lichtenholz 60, 35043 Marburg, Deutschland
| | - A. Jerrentrup
- Zentrum für Notfallmedizin, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland
| | - B. Schieffer
- Zentrum für Notfallmedizin, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland
| | - S. Betz
- Zentrum für Notfallmedizin, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland
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Schmid A, Vlacil AK, Schuett J, Karrasch T, Schieffer B, Schäffler A, Grote K. Anti-Inflammatory Effects of C1q/Tumor Necrosis Factor-Related Protein 3 (CTRP3) in Endothelial Cells. Cells 2021; 10:2146. [PMID: 34440913 PMCID: PMC8391708 DOI: 10.3390/cells10082146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 01/18/2023] Open
Abstract
The C1q/TNF-related protein 3 (CTRP3) represents a pleiotropic adipokine reciprocally associated with obesity and type 2 diabetes mellitus and exhibits anti-inflammatory properties in relation to lipopolysaccharides (LPS)-mediated effects in adipocytes, as well as monocytes/macrophages. Here, we focused on the influence of CTRP3 on LPS-mediated effects in endothelial cells in order to expand the understanding of a possible anti-inflammatory function of CTRP3 in a setting of endotoxemia. An organ- and tissue-specific expression analysis by real-time PCR revealed a considerable Ctrp3 expression in various adipose tissue compartments; however, higher levels were detected in the aorta and in abundantly perfused tissues (bone marrow and the thyroid gland). We observed a robust Ctrp3 expression in primary endothelial cells and a transient upregulation in murine endothelial (MyEND) cells by LPS (50 ng/mL). In MyEND cells, CTRP3 inhibited the LPS-induced expression of interleukin (Il)-6 and the tumor necrosis factor (Tnf)-α, and suppressed the LPS-dependent expression of the major endothelial adhesion molecules Vcam-1 and Icam-1. The LPS-induced adhesion of monocytic cells to an endothelial monolayer was antagonized by CTRP3. In C57BL/6J mice with an LPS-induced systemic inflammation, exogenous CTRP3 did not affect circulating levels of TNF-α, ICAM-1, and VCAM-1. In conclusion, we characterized CTRP3 beyond its function as an adipokine in a setting of vascular inflammation. CTRP3 inhibited LPS-induced endothelial expression of adhesion molecules and monocyte cell adhesion, indicating an important vascular anti-inflammatory role for CTRP3 in endotoxemia.
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Affiliation(s)
- Andreas Schmid
- Department of Internal Medicine III, University of Giessen, 35390 Giessen, Germany; (T.K.); (A.S.)
| | - Ann-Kathrin Vlacil
- Department of Cardiology and Angiology, Philipps-University Marburg, 35037 Marburg, Germany; (A.-K.V.); (J.S.); (B.S.); (K.G.)
| | - Jutta Schuett
- Department of Cardiology and Angiology, Philipps-University Marburg, 35037 Marburg, Germany; (A.-K.V.); (J.S.); (B.S.); (K.G.)
| | - Thomas Karrasch
- Department of Internal Medicine III, University of Giessen, 35390 Giessen, Germany; (T.K.); (A.S.)
| | - Bernhard Schieffer
- Department of Cardiology and Angiology, Philipps-University Marburg, 35037 Marburg, Germany; (A.-K.V.); (J.S.); (B.S.); (K.G.)
| | - Andreas Schäffler
- Department of Internal Medicine III, University of Giessen, 35390 Giessen, Germany; (T.K.); (A.S.)
| | - Karsten Grote
- Department of Cardiology and Angiology, Philipps-University Marburg, 35037 Marburg, Germany; (A.-K.V.); (J.S.); (B.S.); (K.G.)
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Vlacil AK, Bänfer S, Jacob R, Schieffer B, Grote K. Microplastic particles induce endothelial activation. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.595] [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: 11/16/2022]
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Thiele H, Freund A, Gimenez MR, de Waha-Thiele S, Akin I, Pöss J, Feistritzer HJ, Fuernau G, Graf T, Nef H, Hamm C, Böhm M, Lauten A, Schulze PC, Voigt I, Nordbeck P, Felix SB, Abel P, Baldus S, Laufs U, Lenk K, Landmesser U, Skurk C, Pieske B, Tschöpe C, Hennersdorf M, Wengenmayer T, Preusch M, Maier LS, Jung C, Kelm M, Clemmensen P, Westermann D, Seidler T, Schieffer B, Rassaf T, Mahabadi AA, Vasa-Nicotera M, Meincke F, Seyfarth M, Kersten A, Rottbauer W, Boekstegers P, Muellenbach R, Dengler T, Kadel C, Schempf B, Karagiannidis C, Hopf HB, Lehmann R, Bufe A, Baumanns S, Öner A, Linke A, Sedding D, Ferrari M, Bruch L, Goldmann B, John S, Möllmann H, Franz J, Lapp H, Lauten P, Noc M, Goslar T, Oerlecke I, Ouarrak T, Schneider S, Desch S, Zeymer U. Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - Design and rationale of the ECLS-SHOCK trial. Am Heart J 2021; 234:1-11. [PMID: 33428901 DOI: 10.1016/j.ahj.2021.01.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In acute myocardial infarction complicated by cardiogenic shock the use of mechanical circulatory support devices remains controversial and data from randomized clinical trials are very limited. Extracorporeal life support (ECLS) - venoarterial extracorporeal membrane oxygenation - provides the strongest hemodynamic support in addition to oxygenation. However, despite increasing use it has not yet been properly investigated in randomized trials. Therefore, a prospective randomized adequately powered clinical trial is warranted. STUDY DESIGN The ECLS-SHOCK trial is a 420-patient controlled, international, multicenter, randomized, open-label trial. It is designed to compare whether treatment with ECLS in addition to early revascularization with percutaneous coronary intervention or alternatively coronary artery bypass grafting and optimal medical treatment is beneficial in comparison to no-ECLS in patients with severe infarct-related cardiogenic shock. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoint of ECLS-SHOCK is 30-day mortality. Secondary outcome measures such as hemodynamic, laboratory, and clinical parameters will serve as surrogate endpoints for prognosis. Furthermore, a longer follow-up at 6 and 12 months will be performed including quality of life assessment. Safety endpoints include peripheral ischemic vascular complications, bleeding and stroke. CONCLUSIONS The ECLS-SHOCK trial will address essential questions of efficacy and safety of ECLS in addition to early revascularization in acute myocardial infarction complicated by cardiogenic shock.
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Affiliation(s)
- Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
| | - Anne Freund
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Maria Rubini Gimenez
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Janine Pöss
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Hans-Josef Feistritzer
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Tobias Graf
- University Heart Center Luebeck, Luebeck, Germany
| | - Holger Nef
- University Clinic Giessen, Giessen, Germany
| | - Christian Hamm
- University Clinic Giessen, Giessen, Germany; Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | | | | | | | - Ingo Voigt
- Contilia Elisabeth-Krankenhaus, Essen, Germany, Essen, Germany
| | | | - Stephan B Felix
- Dept. of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Peter Abel
- Dept. of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Baldus
- Heart Center Cologne, University Clinic Cologne, Cologne, Germany
| | | | | | | | | | - Burkert Pieske
- Charité University Medicine, Campus Virchow Klinikum and German Heart Center and Berlin Brandenburger Center for Regenerative Therapies (BCRT) of the Berlin Institute of Health (BIH), Berlin, Germany
| | - Carsten Tschöpe
- Charité University Medicine, Campus Virchow Klinikum and German Heart Center and Berlin Brandenburger Center for Regenerative Therapies (BCRT) of the Berlin Institute of Health (BIH), Berlin, Germany
| | | | | | | | - Lars S Maier
- University Clinic Regensburg, Regensburg, Germany
| | | | - Malte Kelm
- University Clinic Düsseldorf, Düsseldorf, Germany
| | | | | | - Tim Seidler
- Heart Center Göttingen, University Medicine Göttingen, Göttingen, Germany
| | | | - Tienush Rassaf
- Dept. of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, Germany
| | - Amir-Abbas Mahabadi
- Dept. of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, Germany
| | | | | | - Melchior Seyfarth
- Heart Center Wuppertal; Witten-Herdecke University, Wuppertal, Germany
| | | | | | | | | | - Thomas Dengler
- SLK Clinic Bad Friedrichshall, Bad Friedrichshall, Germany
| | | | | | | | | | | | - Alexander Bufe
- Helios Clinic Krefeld, Krefeld, University Witten/Herdecke, Germany
| | | | | | - Axel Linke
- Heart Center Dresden - Technical University Dresden, Dresden, Germany
| | | | | | | | | | - Stefan John
- Paracelsius Private University, Clinic Nuremberg, Campus South, Nuremberg, Germany
| | | | | | | | | | - Marko Noc
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tomaz Goslar
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Steffen Desch
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Chatzis G, Syntila S, Schuett H, Waechter C, Ahrens H, Markus B, Divchev D, Rogmann M, Karatolios K, Bouras G, Schieffer B, Luesebrink U. Left Ventricle Architecture and Valvular Integrity Following Microaxial Mechanical Support: A Two-Year Follow-Up Study. J Clin Med 2021; 10:jcm10061273. [PMID: 33803898 PMCID: PMC8003263 DOI: 10.3390/jcm10061273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Although the use of microaxilar mechanical circulatory support systems may improve the outcome of patients with cardiogenic shock (CS), little is known about its effect on the long-term structural integrity of left ventricular (LV) valves as well as on the development of LV-architecture. Therefore, we aimed to study the integrity of the LV valves and architecture and function after Impella support. Thus, 84 consecutive patients were monitored over two years having received ImpellaTM CP (n = 24) or 2.5 (n = 60) for refractory CS (n = 62) or for high-risk percutaneous coronary interventions (n = 22) followed by optimal medical treatment. Beside a significant increase in LV ejection fraction after two years (p ≤ 0.03 vs. pre-implantation), we observed a statistically significant decrease in LV dilation (p < 0.001) and severity of mitral valve regurgitation (p = 0.007) in the two-year follow-up period, suggesting an improved LV architecture. Neither the duration of support, nor the size of the Impella device or the indication for its use revealed any devastating impact on aortic or mitral valve integrity. These findings indicate that Impella device is a safe means of support of LV-function without detrimental long-term effects on the structural integrity of LV valves regardless of the size of the device or the indication of support.
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Affiliation(s)
- Georgios Chatzis
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
- Correspondence: ; Tel.: +49-64-215-861-031
| | - Styliani Syntila
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Harald Schuett
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Christian Waechter
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Holger Ahrens
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Birgit Markus
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Dimitar Divchev
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Marc Rogmann
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Konstantinos Karatolios
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Georgios Bouras
- Yale School of Medicine, Yale University, New Heaven, CT 06510, USA;
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
| | - Ulrich Luesebrink
- Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35043 Marburg, Germany; (S.S.); (H.S.); (C.W.); (H.A.); (B.M.); (D.D.); (M.R.); (K.K.); (B.S.); (U.L.)
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Abstract
COVID-19 („coronavirus disease 2019“) ist eine Herausforderung für unser Gesundheitssystem und gleichzeitig eine der herausragenden Katalysatoren erfolgreicher translationaler Forschung. COVID-19 ist nicht nur eine simple Viruserkrankung des Bronchialsystems, sondern eine pandemisch auftretende, hyperinflammatorische Multiorganerkrankung. Das Herz-Kreislauf-System spielt dabei eine kausale Rolle, da SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) Wirtszellen über ACE(„angiotensin-converting enzyme“)-2, ein Enzym des Renin-Angiotensin-Systems, befällt. Darüber hinaus spielen kardiovaskuläre Komorbiditäten und Risikofaktoren wie Bluthochdruck, Diabetes und Adipositas eine wichtige Rolle für die Schwere der Krankheitsverläufe. Zusätzliche Risikofaktoren wie Geschlecht, Alter, Genetik und Luftverschmutzung modulieren sowohl die Schwere der SARS-CoV-2-Infektion als auch kardiovaskuläre Erkrankungen. Als Folge von COVID-19 kommt es zu vermehrten Thrombosen, Herzinfarkten, Herzmuskelentzündungen und Vaskulitiden, die das kardiovaskuläre System direkt schädigen und wesentlich zur Morbidität und Mortalität beitragen. Erkenntnisse aus zahlreichen Studien zu Krankheitsverläufen von SARS-CoV-2-infizierten Patienten haben zu besseren Therapiemöglichkeiten geführt, die nun in der zweiten Welle zum Teil standardisiert und insbesondere auch an Komplikationen des kardiovaskulären Systems angepasst wurden und werden. In diesem Review geben wir einen kurzen Überblick über die Pathophysiologie des SARS-CoV-2-Virus allgemein sowie auch spezifisch auf das kardiovaskuläre System. Daraus folgend, fassen wir die aktuellen Therapieansätze und deren pathophysiologische Grundlagen (Stand November 2020) zusammen.
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Affiliation(s)
- Elisabeth Schieffer
- Institut für Sportmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Bernhard Schieffer
- Klinik für Kardiologie, Angiologie and Intensivmedizin, Philips-Universität Marburg, Marburg, Deutschland
| | - Denise Hilfiker-Kleiner
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Nef HM, Elsässer A, Möllmann H, Abdel-Hadi M, Bauer T, Brück M, Eggebrecht H, Ehrlich JR, Ferrari MW, Fichtlscherer S, Hink U, Hölschermann H, Kacapor R, Koeth O, Korboukov S, Lamparter S, Laspoulas AJ, Lehmann R, Liebetrau C, Plücker T, Pons-Kühnemann J, Schächinger V, Schieffer B, Schott P, Schulze M, Teupe C, Vasa-Nicotera M, Weber M, Weinbrenner C, Werner G, Hamm CW, Dörr O. Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study. Clin Res Cardiol 2020; 110:292-301. [PMID: 33219854 PMCID: PMC7680078 DOI: 10.1007/s00392-020-01780-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Aims During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region. Methods and results Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99–1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01–1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05–1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures. Conclusion During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality. Graphic abstract ![]()
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Affiliation(s)
- Holger M Nef
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany. .,Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany.
| | | | - Helge Möllmann
- St.-Johannes-Hospital Klinik Für Innere Medizin I, Dortmund, Germany
| | | | - Timm Bauer
- Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Martin Brück
- Department of Cardiology, Lahn-Dill-Kliniken, Klinikum Wetzlar, Wetzlar, Germany
| | - Holger Eggebrecht
- Department of Cardiology, Agaplesion Frankfurter Diakonie Kliniken, Frankfurt, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Markus W Ferrari
- Department of Cardiology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany
| | - Ulrich Hink
- Department of Cardiology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | | | - Rifat Kacapor
- Department of Cardiology, Kliniken Des Main-Taunus-Kreises, Bad Soden am Taunus, Germany
| | - Oliver Koeth
- Department of Cardiology, GPR Gesundheits- Und Pflegezentrum Rüsselsheim, Rüsselsheim, Germany
| | | | - Steffen Lamparter
- Department of Cardiology, Diakonie-Krankenhaus Wehrda, Marburg, Germany
| | - Alexander J Laspoulas
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
| | - Ralf Lehmann
- Department of Cardiology, Asklepios Kliniken Langen, Langen, Germany
| | | | - Tobias Plücker
- Department of Cardiology, Eichhof-Stiftung Lauterbach, Lauterbach, Germany
| | - Jörn Pons-Kühnemann
- Justus Liebig University Giessen, Medical Statistics, Institute of Medical Informatics, Giessen, Germany
| | | | - Bernhard Schieffer
- Department of Internal Medicine/Cardiology and Angiology, University Hospital of Marburg, Marburg, Germany
| | - Peter Schott
- Department of Cardiology, Klinikum Werra Meissner GmbH, Eschwege, Germany
| | - Matthias Schulze
- Department of Cardiology, Asklepios Schwalm-Eder-Kliniken, Schwalmstadt, Germany
| | - Claudius Teupe
- Department of Cardiology, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany
| | | | - Michael Weber
- Department of Cardiology, Kreisklinik Groß-Umstadt, Groß-Umstadt, Germany
| | | | - Gerald Werner
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - Christian W Hamm
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Oliver Dörr
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
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Hatzis G, Ahrens H, Karatolios K, Markus B, Divchev D, Syntila S, Schuett H, Schieffer B, Luesebrink U. Left ventricle unloading and valvular integrity following microaxial mechanical circulatory support: a two year follow-up study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although the use of mechanical circulatory support (MCS) systems may improve the outcome of patients with cardiogenic shock (CS) due to myocardial infarction, little is known about its effect on the long-term structural integrity of left-ventricular (LV) valves as well as on the development of LV- architecture.
Methods
84 consecutive patients were monitored over 2 years having received microaxillar MCS device (ImpellaTM CP or 2.5) for complete coronary revascularization followed by optimal medical treatment.
Results
62 patients were treated for severe cardiogenic shock and compared with 22 patients receiving short-term microaxillar MCS for high risk percutaneous coronary interventions (PCI). 24 patients of the total population received Impella CP (14F motor pump) and the remaining 60 patients received Impella 2.5 (12F motor pump). Beside a significant increase in LV-ejection fraction after 2 years (p≤0.03 vs. pre implantation) in total cohort, we observed a statistically significant decrease in LV-dilation (p<0.001) and the severity of mitral valve regurgitation (p=0.007) in the 2 year follow-up period suggesting an improved LV-architecture. Neither the duration of support, nor the size of the MCS device or the indication for its use revealed any devastating impact on aortic or mitral valve integrity.
Conclusions
These findings indicate that beside complete revascularization and optimal medical treatment, microaxillar transvalvular MCS device supports the restoration of LV-architecture without detrimental long-term effects on the structural integrity of LV valves regardless of the size of the device or the duration of support.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Hatzis
- Philipps University of Marburg, Marburg, Germany
| | - H Ahrens
- Philipps University of Marburg, Marburg, Germany
| | - K Karatolios
- Philipps University of Marburg, Marburg, Germany
| | - B Markus
- Philipps University of Marburg, Marburg, Germany
| | - D Divchev
- Philipps University of Marburg, Marburg, Germany
| | - S Syntila
- Philipps University of Marburg, Marburg, Germany
| | - H Schuett
- Philipps University of Marburg, Marburg, Germany
| | - B Schieffer
- Philipps University of Marburg, Marburg, Germany
| | - U Luesebrink
- Philipps University of Marburg, Marburg, Germany
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Hatzis G, Markus B, Luesebrink U, Ahrens H, Divchev D, Syntila S, Schieffer B, Karatolios K. Early Impella support in post-cardiac arrest cardiogenic shock complicating acute myocardial infarction improves short and long term survival. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Early mechanical circulatory support with Impella may improve survival outcomes in the setting of post-cardiac arrest cardiogenic shock (CS) after out of hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI). However, the optimal timing to initiate mechanical circulatory support (MCS) in this particular setting remains unclear.
Purpose
We aimed to compare survival outcomes of patients supported with Impella 2.5 before percutaneous coronary intervention (PCI) (pre-PCI) to those supported after PCI (post-PCI).
Methods
Single center study of patients resuscitated from OHCA due to AMI with post-cardiac arrest CS between September 2014 and June 2018. Survival outcomes were compared between those with Impella support before and after PCI.
Results
A total of 65 consecutive patients with infarct-related post-cardiac arrest shock supported with Impella 2.5 during admission coronary angiogram were included. All patients were in profound CS requiring catecholamines on admission. Overall survival to discharge and at 12-months was 44.6% and 41.5%, respectively. Patients in the pre-PCI group had a higher survival to discharge and at 12-months as compared to patients of the post-PCI group (60.7% versus 32.4%, p=0.03 and 57.1% versus 29.7%, p=0.04, respectively). Moreover, the patients in the early support group demonstrated a greater functional recovery of the left ventricle when Impella support was initiated prior to PCI.
Conclusions
Our results suggest that the early initiation of MCS with Impella 2.5 prior to PCI is associated with improved hospital and 12-month survival in patients with post-cardiac arrest CS complicating AMI.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Hatzis
- Philipps University of Marburg, Marburg, Germany
| | - B Markus
- Philipps University of Marburg, Marburg, Germany
| | - U Luesebrink
- Philipps University of Marburg, Marburg, Germany
| | - H Ahrens
- Philipps University of Marburg, Marburg, Germany
| | - D Divchev
- Philipps University of Marburg, Marburg, Germany
| | - S Syntila
- Philipps University of Marburg, Marburg, Germany
| | - B Schieffer
- Philipps University of Marburg, Marburg, Germany
| | - K Karatolios
- Philipps University of Marburg, Marburg, Germany
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Markus B, Kreutz J, Schieffer B. Lifestyle and severe SARS-CoV-2 infections: Does the individual metabolic burden determines the outcome? J Renin Angiotensin Aldosterone Syst 2020; 21:1470320320963929. [PMID: 33040679 PMCID: PMC7550949 DOI: 10.1177/1470320320963929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Birgit Markus
- Department of Cardiology, Angiology and Intensive Care
Medicine, Philipps University of Marburg, University Hospital (UKGM), Marburg,
Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology and Intensive Care
Medicine, Philipps University of Marburg, University Hospital (UKGM), Marburg,
Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Intensive Care
Medicine, Philipps University of Marburg, University Hospital (UKGM), Marburg,
Germany
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46
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Parahuleva MS, Worsch M, Euler G, Choukeir M, Mardini A, Parviz B, Kanse SM, Portig I, Khayrutdinov E, Schieffer B, Markus B. Factor VII Activating Protease Expression in Human Platelets and Accumulation in Symptomatic Carotid Plaque. J Am Heart Assoc 2020; 9:e016445. [PMID: 32856552 PMCID: PMC7660758 DOI: 10.1161/jaha.120.016445] [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] [Indexed: 01/22/2023]
Abstract
Background Factor VII activating protease (FSAP) is of interest as a marker for vascular inflammation and plaque destabilization. The aim of this study was to analyze the expression profile of FSAP in endarterectomy specimens that were taken from patients with asymptomatic and symptomatic carotid atherosclerotic plaques and to compare them with circulating FSAP levels. Methods and Results Plasma FSAP concentration, activity, and mRNA expression were measured in endarterectomy specimens and in monocytes and platelets. Plaque and plasma FSAP levels were higher in symptomatic patients (n=10) than in asymptomatic patients (n=14). Stronger FSAP immunostaining was observed in advanced symptomatic lesions, in intraplaque hemorrhage‐related structures, and in lipid‐rich areas within the necrotic core. FSAP was also colocalized with monocytes and macrophages (CD11b/CD68‐positive cells) and platelets (CD41‐positive cells) of the plaques. Moreover, human platelets expressed FSAP in vitro, at both the mRNA and protein levels. Expression is stimulated by thrombin receptor‐activating peptide and ADP and reduced by acetylsalicylic acid. Conclusions Plasma FSAP levels were significantly increased in patients with symptomatic carotid stenosis and thus may be involved in plaque development This plaque‐associated FSAP may be produced by platelets or macrophages or may be taken up from the circulation. To establish FSAP’s utility as a circulating or plaque biomarker in patients with symptomatic carotid atherosclerotic plaques, further studies are needed.
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Affiliation(s)
- Mariana S Parahuleva
- Department of Cardiology, Angiology and Internal Intensive Care UKGM Marburg Germany
| | - Michael Worsch
- Department of Internal Medicine I/Cardiology and Angiology UKGM Giessen Germany
| | - Gerhild Euler
- Department of Internal Medicine I/Cardiology and Angiology UKGM Giessen Germany
| | - Maryana Choukeir
- Department of Cardiology, Angiology and Internal Intensive Care UKGM Marburg Germany
| | - Amar Mardini
- Department of Cardiology, Angiology and Internal Intensive Care UKGM Marburg Germany
| | - Behnoush Parviz
- Department of Internal Medicine I/Cardiology and Angiology UKGM Giessen Germany
| | - Sandip M Kanse
- Institute for Basic Medical Sciences University of Oslo Norway
| | - Irene Portig
- Department of Cardiology, Angiology and Internal Intensive Care UKGM Marburg Germany
| | - Evgeny Khayrutdinov
- Department of Cardiology, Angiology and Internal Intensive Care UKGM Marburg Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology and Internal Intensive Care UKGM Marburg Germany
| | - Birgit Markus
- Department of Cardiology, Angiology and Internal Intensive Care UKGM Marburg Germany
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Vlacil AK, Schuett J, Ruppert V, Soufi M, Oberoi R, Shahin K, Wächter C, Tschernig T, Lei Y, Liu F, Tietge UJF, Schieffer B, Schuett H, Grote K. Deficiency of Nucleotide-binding oligomerization domain-containing proteins (NOD) 1 and 2 reduces atherosclerosis. Basic Res Cardiol 2020; 115:47. [PMID: 32588196 PMCID: PMC7316681 DOI: 10.1007/s00395-020-0806-2] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Abstract
Atherosclerosis is crucially fueled by inflammatory pathways including pattern recognition receptor (PRR)-related signaling of the innate immune system. Currently, the impact of the cytoplasmic PRRs nucleotide-binding oligomerization domain-containing protein (NOD) 1 and 2 is incompletely characterized. We, therefore, generated Nod1/Nod2 double knockout mice on a low-density lipoprotein receptor (Ldlr)-deficient background (= Ldlr−/−Nod1/2−/−) which were subsequently analyzed regarding experimental atherosclerosis, lipid metabolism, insulin resistance and gut microbiota composition. Compared to Ldlr−/− mice, Ldlr−/−Nod1/2−/− mice showed reduced plasma lipids and increased hepatic expression of the scavenger receptor LDL receptor-related protein 1 after feeding a high-fat diet for 12 weeks. Furthermore, intestinal cholesterol and its bacterial degradation product coprostanol were elevated in Ldlr−/−Nod1/2−/− mice, correlating with the increased abundance of Eubacterium coprostanoligenes as assessed by 3rd generation sequencing of the gut microbiota. Atherosclerotic plaques of Ldlr−/−Nod1/2−/− mice exhibited less lipid deposition and macrophage accumulation. Moreover, macrophages from Ldlr−/−Nod1/2−/− mice showed higher expression of the cholesterol efflux transporters Abca1 and Abcg1 and accordingly reduced foam cell formation. Deficiency of Nod1 and Nod2 led to reduced plaque lipid deposition and inflammatory cell infiltration in atherosclerotic plaques. This might be explained by diminished plasma lipid levels and foam cell formation due to altered expression of key regulators of the hepatic cholesterol pathway as well as differential intestinal cholesterol metabolism and microbiota composition.
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Affiliation(s)
- Ann-Kathrin Vlacil
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Jutta Schuett
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Volker Ruppert
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Muhidien Soufi
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Raghav Oberoi
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Kinan Shahin
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Christian Wächter
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Thomas Tschernig
- Faculty of Medicine, Institute for Anatomy and Cell Biology, Saarland University, Campus Homburg/Saar, Saarbrücken, Germany
| | - Yu Lei
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fan Liu
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Uwe J F Tietge
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Bernhard Schieffer
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Harald Schuett
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany
| | - Karsten Grote
- Cardiology and Angiology, Philipps-University Marburg, Hans-Meerwein-Straße 2, 35043, Marburg, Germany.
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Vlacil AK, Vollmeister E, Bertrams W, Schoesser F, Oberoi R, Schuett J, Schuett H, Huehn S, Bedenbender K, Schmeck BT, Schieffer B, Grote K. Identification of microRNAs involved in NOD-dependent induction of pro-inflammatory genes in pulmonary endothelial cells. PLoS One 2020; 15:e0228764. [PMID: 32353008 PMCID: PMC7192443 DOI: 10.1371/journal.pone.0228764] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
The nucleotide-binding oligomerization domain-containing proteins (NOD) 1 and 2 are mammalian cytosolic pattern recognition receptors sensing bacterial peptidoglycan fragments in order to initiate cytokine expression and pathogen host defense. Since endothelial cells are relevant cells for pathogen recognition at the blood/tissue interface, we here analyzed the role of NOD1- and NOD2-dependently expressed microRNAs (miRNAs, miR) for cytokine regulation in murine pulmonary endothelial cells. The induction of inflammatory cytokines in response to NOD1 and NOD2 was confirmed by increased expression of tumour necrosis factor (Tnf)-α and interleukin (Il)-6. MiRNA expression profiling revealed NOD1- and NOD2-dependently regulated miRNA candidates, of which miR-147-3p, miR-200a-3p, and miR-298-5p were subsequently validated in pulmonary endothelial cells isolated from Nod1/2-deficient mice. Analysis of the two down-regulated candidates miR-147-3p and miR-298-5p revealed predicted binding sites in the 3' untranslated region (UTR) of the murine Tnf-α and Il-6 mRNA. Consequently, transfection of endothelial cells with miRNA mimics decreased Tnf-α and Il-6 mRNA levels. Finally, a novel direct interaction of miR-298-5p with the 3' UTR of the Il-6 mRNA was uncovered by luciferase reporter assays. We here identified a mechanism of miRNA-down-regulation by NOD stimulation thereby enabling the induction of inflammatory gene expression in endothelial cells.
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Affiliation(s)
| | - Evelyn Vollmeister
- Institute for Lung Research/iLung, German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, Marburg, Germany
| | - Wilhelm Bertrams
- Institute for Lung Research/iLung, German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, Marburg, Germany
| | - Florian Schoesser
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Raghav Oberoi
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Jutta Schuett
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Harald Schuett
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Sonja Huehn
- Department of Hematology, Oncology, and Immunology, Philipps-University Marburg, Marburg, Germany
| | - Katrin Bedenbender
- Institute for Lung Research/iLung, German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, Marburg, Germany
| | - Bernd T. Schmeck
- Institute for Lung Research/iLung, German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, Marburg, Germany
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Marburg, Philipps-University Marburg, Marburg, Germany
- Center for Synthetic Microbiology (SYNMIKRO), Philipps-University of Marburg, Marburg, Germany
- German Center for Infection Research (DZIF), partner site Giessen-Marburg-Langen, Marburg, Germany
| | | | - Karsten Grote
- Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
- * E-mail:
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Troidl K, Schubert C, Vlacil AK, Chennupati R, Koch S, Schütt J, Oberoi R, Schaper W, Schmitz-Rixen T, Schieffer B, Grote K. The Lipopeptide MALP-2 Promotes Collateral Growth. Cells 2020; 9:cells9040997. [PMID: 32316253 PMCID: PMC7227808 DOI: 10.3390/cells9040997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022] Open
Abstract
Beyond their role in pathogen recognition and the initiation of immune defense, Toll-like receptors (TLRs) are known to be involved in various vascular processes in health and disease. We investigated the potential of the lipopeptide and TLR2/6 ligand macrophage activating protein of 2-kDA (MALP-2) to promote blood flow recovery in mice. Hypercholesterolemic apolipoprotein E (Apoe)-deficient mice were subjected to microsurgical ligation of the femoral artery. MALP-2 significantly improved blood flow recovery at early time points (three and seven days), as assessed by repeated laser speckle imaging, and increased the growth of pre-existing collateral arteries in the upper hind limb, along with intimal endothelial cell proliferation in the collateral wall and pericollateral macrophage accumulation. In addition, MALP-2 increased capillary density in the lower hind limb. MALP-2 enhanced endothelial nitric oxide synthase (eNOS) phosphorylation and nitric oxide (NO) release from endothelial cells and improved the experimental vasorelaxation of mesenteric arteries ex vivo. In vitro, MALP-2 led to the up-regulated expression of major endothelial adhesion molecules as well as their leukocyte integrin receptors and consequently enhanced the endothelial adhesion of leukocytes. Using the experimental approach of femoral artery ligation (FAL), we achieved promising results with MALP-2 to promote peripheral blood flow recovery by collateral artery growth.
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Affiliation(s)
- Kerstin Troidl
- Max-Planck-Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany; (R.C.); (W.S.)
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, 60488 Frankfurt, Germany; (C.S.); (T.S.-R.)
- Correspondence:
| | - Christian Schubert
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, 60488 Frankfurt, Germany; (C.S.); (T.S.-R.)
| | - Ann-Kathrin Vlacil
- Cardiology and Angiology, Philipps-University Marburg, 35043 Marburg, Germany; (A.-K.V.); (S.K.); (J.S.); (R.O.); (B.S.); (K.G.)
| | - Ramesh Chennupati
- Max-Planck-Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany; (R.C.); (W.S.)
| | - Sören Koch
- Cardiology and Angiology, Philipps-University Marburg, 35043 Marburg, Germany; (A.-K.V.); (S.K.); (J.S.); (R.O.); (B.S.); (K.G.)
| | - Jutta Schütt
- Cardiology and Angiology, Philipps-University Marburg, 35043 Marburg, Germany; (A.-K.V.); (S.K.); (J.S.); (R.O.); (B.S.); (K.G.)
| | - Raghav Oberoi
- Cardiology and Angiology, Philipps-University Marburg, 35043 Marburg, Germany; (A.-K.V.); (S.K.); (J.S.); (R.O.); (B.S.); (K.G.)
| | - Wolfgang Schaper
- Max-Planck-Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany; (R.C.); (W.S.)
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, 60488 Frankfurt, Germany; (C.S.); (T.S.-R.)
| | - Bernhard Schieffer
- Cardiology and Angiology, Philipps-University Marburg, 35043 Marburg, Germany; (A.-K.V.); (S.K.); (J.S.); (R.O.); (B.S.); (K.G.)
| | - Karsten Grote
- Cardiology and Angiology, Philipps-University Marburg, 35043 Marburg, Germany; (A.-K.V.); (S.K.); (J.S.); (R.O.); (B.S.); (K.G.)
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50
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Barth S, Reents W, Zacher M, Kerber S, Diegeler A, Schieffer B, Schreiber M, Lauer B, Kuntze T, Dahmer M, Hamm C, Hamm K. Multicentre propensity-matched comparison of transcatheter aortic valve implantation using the ACURATE TA/neo self-expanding versus the SAPIEN 3 balloon-expandable prosthesis. EUROINTERVENTION 2019; 15:884-891. [PMID: 31270034 DOI: 10.4244/eij-d-18-01120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In the absence of randomised data, we aimed to compare the transapical ACURATE and transfemoral ACURATE neo with the SAPIEN 3 prosthesis using propensity matching. METHODS AND RESULTS From 2012 to 2016, 1,306 patients at three German centres received either the ACURATE/ACURATE neo prosthesis (n=591) or the SAPIEN 3 prosthesis (n=715). Through nearest neighbour matching with exact allocation for access route and centre, pairs of 329 patients (250 transfemoral, 79 transapical) per group were determined. Patients were 81 years old on average and had a logistic EuroSCORE I of 19%. Predilatation and post-dilatation were more frequent in the ACURATE group (97.6% versus 52.1%, p<0.001 for predilatation and 40.4% versus 11.6%, p<0.001 for post-dilatation), but rapid pacing for implantation was used less frequently (37.1% versus 98.2%, p<0.001). More-than-mild aortic regurgitation at postoperative echocardiography was 12.0% for the ACURATE group and 3.1% for the SAPIEN group, p≤0.001). More-than-mild aortic regurgitation in the ACURATE group differed amongst the centres with 6.0% (3/50) in centre A, 34.1% (29/85) in centre B and 3.4% (6/181) in centre C. Patients in the ACURATE group less frequently had pacemaker implantation compared to the SAPIEN 3 group (11.9% versus 18.5%, p=0.020), 30-day mortality was 4.6% versus 2.1%, respectively, p=0.134, and one-year survival was 83.1% (95% CI: 77.6-87.4) versus 88.8% (95% CI: 84.0-92.2). CONCLUSIONS In this propensity score analysis, patients treated with the transapical ACURATE or transfemoral ACURATE neo prosthesis less frequently had pacemakers at 30 days but had more aortic regurgitation and lower one-year survival.
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Affiliation(s)
- Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
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