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Simultaneous determination of electrical conductivity and thickness of nonmagnetic metallic foils using two-sided multifrequency eddy current techniques. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:064701. [PMID: 37862479 DOI: 10.1063/5.0142269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 10/22/2023]
Abstract
In this paper, we describe a simple method for performing multifrequency eddy current characterization of free-standing uniform-thickness metallic foils using a forked inductive coil arrangement. The method involves measuring the mutual inductance between two coils when a foil is present between the coils, and when it is not present; the ratio of these mutual inductances is compared with an analytical solution, and foil conductivity, thickness, and sheet resistance are simultaneously estimated using numerical inversion and least-squares fitting. This method was used to characterize 34 non-ferrous metallic samples with thicknesses between 50 and 640 μm and with conductivities between 0.8 × 107 and 5.8 × 107 S/m. The estimated thicknesses from eddy current characterization agreed well with those measured using confocal optical techniques; the two approaches agreed to within 1 μm for samples that were thinner than 200 μm, and to within 0.5% for samples that had a thickness of 200 μm or greater. The estimated conductivities from eddy current characterization were in close agreement with expected values, given knowledge of the materials used. A particular strength of this approach is that the instrumentation needed is broadly available in research and development laboratories and the associated fixturing is easy to manufacture and assemble. A calibration procedure is described that can be used to reduce errors from geometric uncertainties. This calibration requires a sample that has only a known conductivity or thickness; both do not need to be known. The method described herein is likely extensible to conductivities and thickness well outside the ranges measured as part of this work.
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Discrimination and sexual harassment – Results from the largest German medical university. Eur J Public Health 2022. [PMCID: PMC9594788 DOI: 10.1093/eurpub/ckac131.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Discrimination and sexual harassment in the workplace and in higher education institutions are important public health issues. Here we aim at analyzing the prevalence of discrimination and sexual harassment of lecturers and students at one of the largest teaching hospitals in Europe. We assess whether there are differences between lecturers and students, women and men, and different study programs. Methods An online questionnaire was sent to N = 7095 students of all study programs and N = 2528 lecturers at Charité - Universitätsmedizin Berlin. The survey was conducted from November 2018 to February 2019. We investigated experienced or observed discrimination or sexual harassment at the medical faculty. Furthermore, we analyzed frequency, perpetrators, situational factors, attributed reasons and forms of harassment encountered. Results A total of 964 (14%) students (S) and 275 (11%) of lecturers (L) participated in the survey. Discriminatory behavior was witnessed and/or experienced by 49,6% of students (L: 31%), sexual harassment by 23,6% of students (L: 19,2%). Students state lecturers (85,9%) as main source of discriminatory behavior (L: directors/supervisors: 47,4%; students 41,0%). Sex/Gender (S: 71%; L: 60,3%) is cited most frequently as reason for discriminatory experiences. Female students and faculty experience more discrimination and sexual harassment. Conclusions Discrimination and sexual harassment are prevalent in academic medicine. There are differences in the reasons and sources of discrimination and sexual harassment between students and lecturers. Specific programs for lecturers and students are necessary to educate the faculty on how to prevent and respond to it and whom to address. Key messages • National preventive strategies should be implemented to tackle issues of discrimination and harassment in higher education institutions. • Special attention should be paid to female students and lecturers.
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C-Reactive Protein to Albumin Ratio offers superior risk prediction in patients undergoing mitral valve edge-to-edge repair: a comparison to established surgical risk scores. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The population of patients with relevant mitral regurgitation (MR) who stand to gain optimal benefit from mitral valve transcatheter edge-to-edge repair (TEER) remains to be determined. Prior to TEER, a heart-team approach with interdisciplinary decision-making is mandatory integrating both the patient profile and relevant co-morbidities. In addition, the application of established surgical risk scores is recommended by current guidelines. Whether alternative risk prediction is more suitable for this fragile patient cohort burdened with various co-morbidities has not been examined in detail. A simplified approach may be achieved by using the C-Reactive Protein to Albumin Ratio (CAR), but its value in TEER is unclear.
Methods
This single-center, retrospective study thought to determine long-term prognostic accuracy of different risk scores in patients with relevant MR undergoing TEER. For this analysis, 316 patients with a median follow-up time of 5.81 years were included. The primary outcome measure was defined as all-cause mortality. ROC analysis was conducted for the identification of the optimal CAR threshold, subsequently dichotomizing patients into two groups (CAR ≤0.4 and CAR >0.4) estimating their long-term event rate using the Kaplan-Meier method. In addition, we evaluated the prognostic value of CAR compared to two conventional surgical risk scores (logistic EuroSCORE and Society of Thoracic Surgeons [STS] risk score) using C-Index analysis.
Results
Among 316 high-risk patients undergoing TEER (mean age 75.6±8.2 years, 61.7% male, median logistic EuroSCORE 19.9% [11.7; 31.6], median STS Score 3.8% [2.2; 5.7]), 176 (55.7%) patients had a CAR value ≤0.4. Patients with an elevated CAR (>0.4) predominantly suffered from a higher burden of co-morbidities, such as peripheral artery disease (p=0.001), chronic obstructive pulmonary disease (p=0.044), and chronic kidney disease (p=0.015). Consequently, these patients had significantly higher logistic EuroSCORE and STS Score than patients with CAR ≤0.4 (logistic EuroSCORE p=0.002; STS Score p<0.001). Stratification according to the CAR threshold of 0.4 led to significant differences in the Cumulative Incidence curves (p<0.001). In addition, log-rank test revealed a superior risk stratification of the simplified CAR approach compared to established surgical risk scores (Figure 1). This effect consequently reflects in a higher adjusted C-Index for CAR (0.608) compared to logistic EuroSCORE (0.502; p<0.001) and STS Score (0.498; p<0.001).
Conclusions
Our data provide first evidence that alternative risk prediction using CAR allows for a feasible and easy-to-use risk prediction in a real-word TEER cohort presenting with advanced age, a high proportion of frailty and numerous co-morbidities. Alternative risk prediction in TEER patients should be investigated in more detail as the established surgical risk scores seem to demonstrate limited applicability in patients scheduled for TEER.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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483 High-pitch Non-ecg-gated Ct Angiography Fortranscatheter Aortic Valvereplacement Planning: A Comparison To A Ecg-gated Cta Protocol And Impact On Clinical Outcome. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Outcomes of patients with severe mitral regurgitation treated with transcatheter mitral valve implantation or medical therapy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients with severe mitral regurgitation (MR) unsuitable for standard therapy (i.e., open-heart surgery and transcatheter edge-to-edge repair [TEER]), often remain on medical therapy (MT) alone. Transcatheter mitral valve implantation (TMVI) may represent an alternative treatment option for these patients.
Purpose
We aimed to investigate differences in anatomical baseline characteristics and echocardiographic outcomes between MR patients unsuitable for standard therapy, that were either treated with TMVI or remained on MT.
Methods
Between 05/2016-02/2021, 121 high-risk patients with severe MR were evaluated for TMVI. Clinical, echocardiographic and functional outcomes between the subgroups of patients treated with TMVI and MT were compared. The primary combined endpoint was all-cause death or heart failure (HF) hospitalization at 1 year. Subgroup analyses were performed to define specific patient subsets favouring either TMVI or MT.
Results
At baseline, there were no differences between the TMVI group (n = 38) and the MT group (n = 44) regarding age (all TMVI vs. MT: 77.0 years [IQR 72.9, 80.1] vs. 79.0 [IQR 76.0, 81.7], p = 0.13), gender (42.1% female vs. 56.8% female, p = 0.27) and estimated surgical risk (EuroSCORE II 4.4% [IQR 2.8, 13.6] vs. 6.4 [IQR 3.4, 10.1], p = 0.72). Patients undergoing TMVI were more frequently treated for secondary MR (68.4%), while primary MR was the most prevalent MR etiology in patients remaining on medical therapy (50.0%). Left ventricular (LV) end-diastolic diameters (LVEDD) were larger and LV ejection fraction (LVEF) was lower in the TMVI group (LVEDD 58.0mm [IQR 51.4, 65.0], LVEF 37.0% [IQR 31.4, 51.2]) compared to the MT group (LVEDD 52.0mm [IQR 46.2, 58.8], LVEF 54.5% [IQR 40.8, 60.0]) (p = 0.02 for LVEDD, p < 0.001 for LVEF). MR was effectively reduced to ≤ mild MR in all patients undergoing TMVI. In the MT group, MR remained severe in 90% of patients after 1 year. The primary composite endpoint occurred numerically more often in the MT group (72.2%) compared to the TMVI group (51.6%, p = 0.061). Regarding the primary endpoint, the subgroups of patients with LVEF 30-49% (HR 0.28 [95%-CI 0.11-0.67], p = 0.004), effective regurgitant orifice area (EROA) <0.4 cm2 (HR 0.30 [95%-CI 0.13-0.71], p = 0.006), tricuspid annular plane systolic excursion (TAPSE) ≥17mm (HR 0.27 [95%-CI 0.11-0.67], p = 0.005) and New York Heart Association functional class III (HR 0.38 [95%-CI 0.18-0.81], p = 0.012) were more likely to benefit from TMVI compared to MT.
Conclusions
In patients with severe MR unsuitable for standard therapy, TMVI represents a reasonable therapeutic alternative yielding effective elimination of MR. While most patients eligible for TMVI suffer from secondary MR, the majority of patients remaining on MT has primary MR. The primary endpoint occurred numerically, yet not statistically, more often in patients on MT. Baseline echocardiography was able to identify subgroups of patients with beneficial outcome after TMVI.
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Characteristics and Outcomes of Patients Undergoing Screening for Transcatheter Mitral Valve Implantation: Results from the CHOICE-MI Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Transcatheter Aortic Valve Implantation after Previous Mitral Valve Repair or Replacement: Technical Considerations and Clinical Outcomes. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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1-Year Outcomes after Transcatheter Mitral Valve Implantation: Results from the Global CHOICE-MI Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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“Health Situation of Women in Germany 2020” - The new report of the Federal Health Reporting is published. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In Germany, there are more than 35 million women. The German Women's Health Report being published in December 2020 by the Federal Health Reporting Unit at the Robert Koch Institute describes their health status.
Methods
The report uses a broad data basis and shows differences and similarities in the health of women and men (‘differences between') as well as within the group of women (‘differences within'). It includes an overview on their health status, health behaviour and health care. Focus chapters are devoted to health over the life course, specific groups of women, e.g. women with disabilities, and specific health topics, e.g. sexual and reproductive health.
Results
Women's average life expectancy has been increasing for many decades. Two thirds of women rate their health as good or very good. The most common cause of death among women are cardiovascular diseases, accounting for around 40% of all deaths. Nevertheless, they are still considered as ‘male' diseases, thus women often underestimate their risk of disease. Women are in general more health conscious than men, e.g. they have a healthier diet. Women use prevention measures, health promotion and health care services more often. Two thirds of those in need of care are women and it is mainly women who are responsible for the care of others. Data gaps exist for certain conditions such as benign gynaecological diseases as well as for certain groups of women, e.g. migrant women.
Conclusions
In Germany, the health status and health care for women are at a high level. But inequalities in the opportunities for a healthy life exist: socio-economic factors such as age, education, occupation, income, family type, migration background and many other aspects have an important impact on their health status. The report provides current data and information for policymakers, science and practice and raises the awareness and the need for sex and gender-appropriate health promotion, prevention and care.
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Diagnostic value and prognostic impact of various invasively derived hemodynamic parameters in patients with severe aortic stenosis undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ejection time (ET) and Acceleration time (AT) have been described as echocardiographic markers for aortic stenosis (AS).1 Moreover, in a recent study time between invasively measured left ventricular and aortic systolic pressure peaks (T-LVAo) was associated with anatomic AS severity.2 However, the diagnostic value of these parameters has not been validated in a larger patient cohort and their prognostic impact in AS patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown.
Purpose
We aimed to assess the diagnostic value and prognostic impact of ET, AT, and T-LVAo as assessed by invasive measurements in patients undergoing TAVI for severe AS.
Methods
This retrospective single-centre analysis studied 1478 patients undergoing TAVI from 2014 to 2019 for severe AS. All patients received echocardiographic, multislice computed tomography (MSCT) and invasive hemodynamic evaluation with simultaneous pressure measurements in left ventricle and aorta prior to TAVI. Anatomic AS severity was assessed according to MSCT-derived aortic valve calcification density (AVCd) defined as calcium volume per annulus area. All hemodynamic parameters were calculated offline using a dedicated software.
Results
Median patients' age was 81.2 (76.8–84.7) years and 807 (54.6%) were women. Predicted operative risk for mortality was 3.8 (2.6–5.7)% according to STS Score. Medians of invasively derived parameters were 70.0 ms (46.0–98.0) for T-LVAo, 308.0 ms (276.0–336.0) for ET, 180.0 ms (146.0–206.0) for AT. In spline analysis correlation of T-LVAo (Spearman: r=0.35; p<0.001) and ET (Spearman: r=0.18; p<0.001) with AVCd was significant but weak. AT showed negligible correlation with ACVd (Spearman: r=−0.05; p=0.089). The optimal cutoff for death (CD) according to C-statistic was 274 ms for ET and 158 ms for AT. Patients with ET or AT ≥ CD showed lower short and mid-term mortality rates compared to patients with ET or AT < CD (ET ≥ vs. < CD: mortality at 1-year: 14.5 vs. 31.9%, 3-years: 28.3 vs. 53.5%, all p<0.001; AT ≥ vs < CD: mortality at 1-year: 15.5 vs. 25.9%, p<0.001, 3-years: 34.0 vs. 41.0%, p=0.0032). Moreover, multivariate analysis for mortality identified ET (HR 0.58 [95% CI 0.43–0.77; p<0.001]) and AT (HR 0.65 [95% CI 0.49–0.86; p=0.0027]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters like LVEF, mean gradient or stroke volume index. In contrast, T-LVAo showed no prognostic impact according to uni- or multivariate analyses.
Conclusion
T-LVAo provides the highest diagnostic value among the investigational hemodynamic parameters, however correlation with AVCd was weak. ET and AT are strong independent outcome predictors beyond clinical risk factors and standard echocardiographic parameters in AS patients following TAVI. Accordingly, use of ET and AT might improve risk assessment in patients scheduled for TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Long-Term survival and functional status in patients with elevated mitral valve pressure gradient after transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A growing number of patients are currently treated for severe mitral regurgitation (MR) using a transcatheter mitral valve repair (TMVr). In clinical routine, the potential risk of elevated post-procedural mitral valve pressure gradient (MPG) may prohibit optimal MR reduction driven by the avoidance of additional clip implantations. Thus, the unfavorable impact on survival and functional outcome of increased MPG in patients undergoing TMVr is currently debatable.
Methods
In this single-center, prospective study, survival and functional outcome of 780 consecutive patients with severe MR undergoing TMVr between September 2008 and January 2020 were investigated. After exclusion of patients with unsuccessful procedure and those lost to follow-up, data of 676 patients with a median follow-up time of 5.26 (5.11, 5.51) years were analyzed. MPG was determined by transthoracic echocardiography at discharge and considered elevated in excess of 4.5 mmHg. Kaplan-Meier analysis as well as multivariable Cox regression models were performed for the impact on elevated MPG on 5-year outcomes for the subgroups of functional MR (FMR) and degenerative MR (DMR). The primary outcome measure was a combined endpoint of death or rehospitalization for congestive heart failure.
Results
Among 676 patients undergoing TMVr (mean age 74.6±8.5 years, 59.0% male, median STS Score 3.9 [interquartile range 2.5; 6.0]), 179 (26.4%) patients had elevated MPG >4.5 mmHg. FMR was present in 426 (63.0%) patients. In the overall patient cohort, Kaplan-Meier and Cox Regression analyses could not demonstrate significant differences for the combined endpoint (p=0.99). In contrast, subgroup analysis according to MR etiology indicated a significant adverse influence of elevated MPG on the combined endpoint as well as functional outcome in patients with DMR, but not with FMR (Figure 1). After adjustment, multivariate Cox Regression analysis showed an inferior prognosis in patients with DMR and elevated MVPG >4.5 mmHg (hazard ratio 1.79 [1.17, 2.72], p=0.0069, Figure 2).
Conclusions
TMVr-patients with DMR and measurable elevated post-procedural MVPG face an inferior prognosis and reduced functional outcomes compared to patients with FMR.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Risk prediction in patients with classical Low-flow, low-gradient aortic stenosis undergoing TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with classical low-flow, low-gradient aortic stenosis (LFLG AS) undergoing transcatheter aortic valve implantation (TAVI) are known to suffer from poor prognosis. Risk prediction is difficult and predictors of outcome are scarce in this complex patient subset.
Purpose
This study aimed to develop a simple score system for risk prediction in patients with classical LFLG AS scheduled for TAVI including baseline clinical, echocardiographic and computed tomography (CT) parameters.
Methods
Among 9,150 patients undergoing TAVI (2008–2019) at five German centers, patients with classical LFLG AS were screened for availability of sufficient CT data for aortic valve calcification (AVC) quantification. Score variables were defined as all variables included into the best performing multivariable regression model. Score performance was assessed by Kaplan-Meier analysis for the endpoint of 1-year all-cause as well as c-index calculation.
Results
A total of 718 patients were included into the study. Predictors of all-cause mortality were male sex (HR 1.27 [0.98, 1.65], p=0.068), chronic obstructive pulmonary disease (HR 1.59 [1.21,2.08], p<0.001), atrial fibrillation (HR 1.33 [1.03,1.70], p=0.026), stroke volume index (HR 0.96 [0.94, 0.98], p<0.001), non-transfemoral access (HR 1.44 [1.09,1.91], p=0.011), pulmonary hypertension (HR 1.58 [1.20,2.08], p=0.0012) and low AVC density (HR 1.49 [1.16,1.90], p=0.0016). A score system was developed ranging from 0 points to 11 points. Kaplan-Meier analysis for low (0–2 points), moderate (3–6 points) and high score (>6 points) demonstrated 1-year mortality rates of 20.9%, 28.9% and 64.3% (p<0.001), respectively. C-index for prediction of 1-year mortality was 0.69 (95%-CI 0.65–0.84). The RELiEF TAVI score outperformed classical risk prediction models like the logistic euroSCORE (c-index 0.60 [95%-CI 0.51–0.72], p=0.013), the EuroSCORE II (c-index 0.57 [95%-CI 0.45–0.70], p=0.039) and the STS PROM (c-index 0.60 [0.48–0.70], p=0.035).
Conclusions
The RELiEF TAVI score is based on simple clinical, echocardiographic and CT parameters and might serve as a helpful tool for risk prediction in the vulnerable subset of patients with classical LFLG AS scheduled for TAVI.
Funding Acknowledgement
Type of funding sources: None. RELiEF TAVI Score
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Abstract
INTRODUCTION Pelvic organ prolapse is a common problem in urogynecological surgery. Abdominal and laparoscopic sacrocolpopexy is currently considered to be the gold standard of treatment. The main problem remains the anatomical point of fixation as well as how sutures are placed. We evaluated the biomechanical difference between an in-line ligament suture versus an orthogonal ligament suture and a single suture versus a continuous suture at the anterior longitudinal ligament in an in-vitro, sacrocolpopexy model. METHODS Biomechanical in-vitro testing was performed on human, non-embalmed, female cadaver pelvises. An Instron test frame (tensinometer) was used for load/ displacement analysis. The average patient age was 75 years. Ligament preparation yielded 15 ligaments available for testing. Recorded parameters were the ultimate load, failure displacement, and stiffness. RESULTS This in-vitro analysis of different suturing methods showed the difference between an orthogonal and an in-line approach to be the ultimate load. Orthogonal sutures displayed an ultimate load of 80 N while in-line suturing yielded only 57 N (p < 0.05). For the anterior longitudinal ligament, this study demonstrated that continuous suture is significantly superior to a single suture regarding failure displacement (p < 0.05). CONCLUSION We established baseline biomechanical parameters for the sacrospinous ligament and anterior longitudinal ligament. An orthogonal suture is superior to an in-line suture in an in-vitro model. A continuous suture is superior to a single suture at the anterior longitudinal ligament. Clinical trials might be able to evaluate whether any clinical significance can be established from these findings.
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Early Results of a Real-World Cohort of Patients Receiving Transcatheter Mitral Valve Implantation Using Dedicated Devices. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Early Commercial Experience with a Novel Balloon-Expandable Transcatheter Heart Valve: 30-Day Outcomes and Implications of Preprocedural Computed Tomography. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Comparison of Two Contemporary Balloon-Expandable Transcatheter Heart Valves: Sapien 3 versus Sapien 3 Ultra. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Feasibility, Safety and Efficacy of Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction (BASILICA) during Transcatheter Aortic Valve Implantation (TAVI): A Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Transcatheter Aortic Valve-in-Valve Implantation versus Redo Surgery: A Contemporary Comparative Analysis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Prevalence and prognostic impact of left ventricular outflow tract calcification in patients with severe aortic stenosis undergoing transfemoral TAVI using second-generation devices. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after TAVI in patients receiving first-generation transcatheter heart valves (THV). Second-generation THV have been shown to improve outcomes of TAVI patients. Thus, aim of this study is to assess the prevalence of LVOT calcification as well as its impact on procedural and clinical outcomes in patients with severe aortic stenosis undergoing transfemoral TAVI with second-generation THV in a real-world patient cohort.
Methods
In this retrospective single-center analysis patients receiving transfemoral TAVI with second-generation THV for the treatment of aortic stenosis (AS) between 05/2012 and 06/2018 and with adequate CT data were included (n=836). Amount of LVOT calcification was measured quantitatively from contrast-enhanced multislice CT using a dedicated software. Baseline characteristics and outcomes were compared according to presence of significant LVOT calcification (none/≤10 mm3 vs. >10 mm3). Procedural and clinical outcome were assessed in accordance with VARC-2 criteria. All-cause mortality was assessed by Kaplan-Meier method, median follow-up was 1.4 years.
Results
Significant LVOT calcification was present in 37.0% of patients. Patients with LVOT calcification were older (all results as follows without (w/o) vs. with (w) LVOT calcification: 81.4 (77.1, 84.8) vs. 82.3 (78.0, 86.3) years, p=0.006), but presented similar STS scores compared to those without LVOT calcification (5.4±4.7 vs. 5.4±3.5%, p=0.94). Moreover, patients with LVOT calcification had higher mean transvalvular gradients at baseline (30.0 (21.0, 41.0) vs. 37.0 (25.7, 47.0) mmHg, p<0.001) and higher aortic valve calcium volume (380.7 (226.8, 632.1) vs. 663.6 (364.5, 1070.3) mm3, p<0.001). There were no significant differences in rate of device success (97.0 vs. 94.2%, p=0.11), renal failure (2.6 vs. 2.3%, p=1.00), myocardial infarction (0.9 vs. 1.2%, p=1.00) or rate of permanent pacemaker implantation at 30 days after TAVI (16.6 vs. 17.2%, p=0.91). However, rate of TIA/stroke was significantly higher in patients with LVOT calcification (2.1 vs. 6.2%, p=0.0098). Furthermore, patients with LVOT calcification had a higher rate of more than mild paravalvular leakage at discharge (3.8 vs. 7.6%, p=0.033). Rate of 1 year all-cause mortality (17.8 vs. 21.2%, p=0.23) was not significantly different between both groups.
Conclusions
Significant LVOT calcification is present in a substantial proportion of patients receiving TAVI. In such patients, higher rates of cerebrovascular events and more than mild PVL occurred compared to those without significant LVOT calcification even with currently available second-generation THV. Although these findings did not translate into higher mortality rates in the present study, they underline the need for further optimization of THV technology in order to improve outcomes among all TAVI patients.
Figure 1. 1-year mortality
Funding Acknowledgement
Type of funding source: None
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Impact of tricuspid regurgitation and its postprocedural reduction on long term outcome in patients undergoing percutaneous mitral valve edge to edge repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prevalence of functional tricuspid valve regurgitation (TR) in the adult population is high and mostly considered as a consequence of left-sided heart failure. In patients with moderate-to-severe and severe mitral regurgitation (MR), relevant concomitant TR is found in about 30–50%. For many years the concept of a reduction of secondary TR after mitral valve surgery has been widely accepted. However, more recently, compelling data have shown that surgically untreated functional TR can persist or even worsen despite the correction of the associated left-sided lesion.
In line with previous research, studies have indicated that preexisting concomitant TR is an independent predictor for adverse outcome in patients undergoing percutaneous mitral valve Edge-to-Edge Repair (pMVR).
Purpose
This study intends to determine the extent to which the severity of tricuspid regurgitation, measured six months after pMVR, impacts the outcome.
Methods
Between September 2008 and July 2018, 805 consecutive patients with moderate-to-severe or severe MR underwent pVMR therapy with the MitraClip device at our center. We exclude patients with missing date of follow-up (n=54) and patients with missing values for baseline tricuspid regurgitation (n=93). We analyze, therefore, data of 658 patients with a median follow-up time of 4.93 (4.2, 4.99) years. Severity of TR was evaluated at baseline and six months after pMVR.
Results
Among 658 high-risk patients (mean age 75.4±8.7 years, 59.7% male, median STS Score 3.9 [2.4, 6.1]), 248 patients were suffering from no/mild (37.6%), 213 from moderate (32.6%) and 197 patients from severe (29.9%) TR. Functional MR was present in 429 (65.5%) patients. Procedural success was achieved in the majority of patients (no/mild TR 90.3%, moderate TR 91.1%, severe TR 90.4%). Overall, mortality rates up to two-year follow-up were highest for patients with severe TR (no/mild TR 30.2%, moderate TR 37.6%, severe TR 42.6%, p=0.023). The risk for overall mortality (Kaplan-Meier analysis, p=0.0027, Figure 1) was related to increasing TR severity. However, Kaplan-Meier analysis showed no relevant differences for the combined endpoint of death and rehospitalization (p=0.058). Interestingly, in a pairwise comparison, the risk for patients with pre-existing severe TR and postprocedural reduction to mild or moderate TR (n=17) was reduced for the combined endpoint (p=0.021) compared to patients with persistent severe TR (n=28).
Conclusion
Moderate and severe TR in high-risk patients undergoing pMVR is associated with an increased risk for overall mortality. While preliminary, the presented data suggest a favorable outcome in patients with a postprocedural reduction in the severity of TR. The results of this study indicate the importance of developing new therapeutic strategies in high-risk patients with combined MR and TR, probably leading to concomitant tricuspid valve interventions.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Acute hemodynamic changes and long term prognostic impact of pulmonary hypertension in patients undergoing percutaneous mitral valve edge to edge repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) due to left heart disease is the most common form of PH. Published literature suggests increased perisurgical mortality in patients undergoing surgical repair in the setting of preexisting PH. The data on the impact of preexisting PH on clinical outcomes after percutaneous Mitral Valve Edge-to-Edge Repair (pMVR) is limited to observational studies and rely mostly on echocardiographic data.
Purpose
The aim of the current study is to evaluate the influence of preexisting PH in patients undergoing pMVR analyzing periprocedural invasive right heart catheterization data.
Methods
Between September 2008 and July 2018, a total of 911 patients with moderate-to-severe or severe mitral regurgitation (MR) underwent pMVR at our center. This analysis includes 331 patients with a complete data set for pre- and postprocedural right heart catheterization and echocardiographic assessment as well as available follow-up information after the implantation. Patients are divided according to the etiology of PH. The combined primary endpoint consists of all-cause mortality and rehospitalization for heart failure. Furthermore, a sub-analysis is performed for all patients with preexisting post-capillary PH. Patients with post-capillary PH are divided into two groups based on a postprocedural decrease of pulmonary artery wedge pressure (mPAWP) below the threshold of 15mmHg. Univariate and multivariate Cox regression analyses are performed to assess the influence on long-term outcome.
Results
Of all 331 patients (57.7% [n= 191] male) undergoing pMVR, 195 (62.1%) had functional MR. Median ejection fraction was 40.5% (29.3, 54.0). Patients were followed-up for a maximum of 4.41 years and the median follow-up time was 1.98 years. Preexisting PH (mean pulmonary artery pressure ≥25 mmHg) was found in 236 (71.1%) patients: 49 patients had pre-capillary PH (≤15 mmHg), 187 had post-capillary PH (pcPH; n=183; mPAWP >15 mmHg). In Kaplan-Meier analysis, no statistically significant difference could be found in overall mortality in patients without or with PH, irrespective of etiology (p=0.43). However, in patients suffering from post-capillary PH, patients with a postprocedural reduction of mPAWP below the threshold of 15mmHg showed a significantly lower risk for overall long-term mortality compared to patients without a relevant mPAWP reduction (p=0.018). Multivariate analysis revealed acute postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH to have a significant influence on mortality (HR 2.81 [1.35, 5.86]; p=0.006; Figure 1).
Conclusion
In contrast to previously published findings, the present results were not able to show a significant impact of PH, disregarding its etiology, on outcome. Nevertheless, a postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH is associated with a favorable outcome.
Figure 1
Funding Acknowledgement
Type of funding source: None
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The adverse impact of HFpEF in patients with aortic stenosis: evaluation of the H2FPEF score for risk assessment among patients with preserved ejection fraction undergoing TAVI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The H2FPEF score enables identification of patients with high probability of prevalent heart failure with preserved ejection fraction (HFpEF). High H2FPEF scores have proven to be associated with adverse outcome in patients with known HFpEF.
Objective
The aim of this study was to assess the prognostic impact of the H2FPEF score in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) for severe aortic stenosis (AS) and preserved left ventricular ejection fraction (EF).
Methods
In this multi-centre study a total of 832 patients from two German high-volume centres, who received TAVI for severe AS and preserved EF (≥50%), were identified for calculation of the H2FPEF score. Score variables included BMI >30 kg/m2, arterial hypertension, atrial fibrillation, systolic pulmonary artery pressure >31 mmHg, age >60 years, and invasively assessed elevated LV filling pressure. Patients were dichotomized according to low (1–5 points; n=570) and high H2FPEF scores (6–9 points; n=262). Kaplan-Meier and Cox regression analyses were applied to assess the prognostic impact of the H2FPEF score. Median follow-up time was 1.08 years.
Results
Patients presenting with high H2FPEF scores had higher prevalence of moderate to severe mitral and tricuspid regurgitation compared to those with low H2FPEF scores. Stroke volume index (SVI) (Figure 1A) and mean transvalvular gradient (Pmean) consistently decreased with increasing H2FPEF score. All-cause mortality 30 days after TAVI was significantly higher in patients with high H2FPEF scores (p<0.0001). This finding was consistent both after 1 year (p<0.0001) and 3 years (p<0.0001) (Figure 1B). Multivariate analysis revealed a high H2FPEF score to be independently predictive for all-cause mortality (HR 1.62, 95% CI: 1.11–2.38, p=0.013). Among the single H2FPEF score parameters atrial fibrillation was the strongest independent predictor of adverse outcome.
Conclusion
An elevated H2FPEF score of ≥6 is independently predictive for mortality in patients with preserved EF undergoing TAVI for severe AS, which might be due to a higher proportion of paradoxical low flow low gradient AS in these patients. Our findings provide evidence that the H2FPEF score may help identify AS patients with preserved ejection fraction that are at higher risk for adverse outcome after TAVI.
Spline/SVI (A) and 3y-mortality KM (B)
Funding Acknowledgement
Type of funding source: None
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Early results of a real-world series with two transapical transcatheter mitral valve replacement devices. Clin Res Cardiol 2020; 110:411-420. [PMID: 33074368 PMCID: PMC7907022 DOI: 10.1007/s00392-020-01757-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Aims Transcatheter mitral valve replacement (TMVR) with dedicated devices promises to fill the treatment gap between open-heart surgery and edge-to-edge repair for patients with severe mitral regurgitation (MR). We herein present a single-centre experience of a TMVR series with two transapical devices. Methods and results A total of 11 patients were treated with the Tendyne™ (N = 7) or the Tiara™ TMVR systems (N = 4) from 2016 to 2020 either as compassionate-use procedures or as commercial implants. Clinical and echocardiographic data were collected at baseline, discharge and follow-up and are presented in accordance with the Mitral Valve Academic Research Consortium (MVARC) definitions. The study cohort [age 77 years (73, 84); 27.3% male] presented with primary (N = 4), secondary (N = 5) or mixed (N = 2) MR etiology. Patients were symptomatic (all NYHA III/IV) and at high surgical risk [logEuroSCORE II 8.1% (4.0, 17.4)]. Rates of impaired RV function (72.7%), severe pulmonary hypertension (27.3%), moderate or severe tricuspid regurgitation (63.6%) and prior aortic valve replacement (63.6%) were high. Severe mitral annulus calcification was present in two patients. Technical success was achieved in all patients. In 90.9% (N = 10) MR was completely eliminated (i.e. no or trace MR). Procedural and 30-day mortality were 0.0%. At follow-up NYHA class was I/II in the majority of patients. Overall mortality after 3 and 6 months was 10.0% and 22.2%. Conclusions TMVR was performed successfully in these selected patients with complete elimination of MR in the majority of patients. Short-term mortality was low and most patients experienced persisting functional improvement. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01757-z) contains supplementary material, which is available to authorized users.
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Laparoskopische bilaterale Uterosakropexie (laUSA) zur apikalen Rekonstruktion – Weiterentwicklung einer Technik zum Ersatz beider Uterosakralligamente unter Erhalt des Uterus. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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25
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Urge II Studie – randomisierter Vergleich von Solifenacin mit dem operativen Ersatz der Pubourethralligamente (nach vorheriger apikaler Korrektur) zur Behandlung einer Misch-oder Dranginkontinenz. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Bilaterale Cervicosakropexie zur apikalen Aufhängung – Vergleich klinischer Ergebnisse zwischen Laparotomie und Laparoskopie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Laparoskopische bilaterale Cervicosakropexie zur Behandlung eines apikalen Deszensus mit Harninkontinenz – Wirksamkeit ein Jahr postoperativ. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Exosomes, virus-sized nanovesicles, are utilized as messenger systems of our body to communicate with other body cells and regulate immune functions. Almost all cells produce exosomes and are able to interact with immune cells in the blood stream and peripheral body areas. Different markers on the surface of exosomes are necessary for immune cell adhesion and interaction. Furthermore, many types of exosome-immune cell interaction, such as surface receptor contact and phagocytosis, are known. As carriers of different cargos, exosomes affect different immune cell types in head and neck cancers: So far, T cells, natural killer cells, macrophages, and dendritic cells have been described in this context. For diagnostic purposes, a combined analysis of different parameters including protein amount, nucleic acid/protein expression, and the immunosuppressive impact of exosomes could empower exosomes as useful tools for evaluation of tumor promotion and progression in the future.
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Rapid SARS-CoV-2 inactivation by commonly available chemicals on inanimate surfaces. J Hosp Infect 2020; 106:633-634. [PMID: 32916211 PMCID: PMC7480442 DOI: 10.1016/j.jhin.2020.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/01/2020] [Indexed: 12/23/2022]
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Coherent Electron Optics with Ballistically Coupled Quantum Point Contacts. PHYSICAL REVIEW LETTERS 2020; 125:107701. [PMID: 32955297 DOI: 10.1103/physrevlett.125.107701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
The realization of integrated quantum circuits requires precise on-chip control of charge carriers. Aiming at the coherent coupling of distant nanostructures at zero magnetic field, here we study the ballistic electron transport through two quantum point contacts (QPCs) in series in a three terminal configuration. We enhance the coupling between the QPCs by electrostatic focusing using a field effect lens. To study the emission and collection properties of QPCs in detail we combine the electrostatic focusing with magnetic deflection. Comparing our measurements with quantum mechanical and classical calculations we discuss generic features of the quantum circuit and demonstrate how the coherent and ballistic dynamics depend on the details of the QPC confinement potentials.
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Results of an Early Series of Transcatheter Mitral Valve Implantation with Dedicated Devices: Experience with Three Different Transapical and Transseptal Devices. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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P4576Prognostic value of high-sensitivity troponin I measured by two assays in patients presenting with suspected myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Troponin is the gold-standard biomarker for diagnosing acute myocardial infarction (AMI). High-sensitivity assayed troponin has furthermore proven to be a promising biomarker for the prediction of future adverse cardiovascular events.
Objective
Aim of the current study was to assess and compare the prognostic value of a single troponin I measurement in patients with suspected AMI analysed by a novel high-sensitive Troponin I (hs-TnI) assay, promising detection of very low troponin I plasma levels, as well as by a well-established hs-TnI assay.
Methods
Data was derived from two prospective studies of patients presenting with suspected AMI to the emergency department. Hs-TnI was measured in a total of 2,312 patients using both a novel hs-TnI assay (1; Singulex Clarity cTnI) and a widely applied and approved hs-TnI assay (2; Abbott Diagnostics, ARCHITECT i1000SR). The prognostic impact for overall mortality of both hs-TnI assays was assessed in the total patient cohort as well as in the subgroups of patients with AMI (n=498) and without AMI (n=1,813). Kaplan-Meier analyses stratified by hs-TnI tertiles in each subgroup were performed. Moreover, prognostic impacts of both hs-TnI assays were analysed in a multiple adjusted cox regression model. We compared the performance of both hs-TnI assays in predicting adverse outcome using c-statistics. Median follow up time was 2.4 years.
Results
Patients with AMI presented with significantly higher hs-TnI values on admission. Unadjusted Kaplan-Meier analysis survival curves in the entire study population (Figure 1) as well as in the non-AMI subgroup indicated a significantly higher event-rate in the third tertiles of both hs-TnI assays for overall mortality. In contrast, irrespective of the used assay we found no association between troponin I plasma levels and overall mortality in the AMI group. Cox regression models revealed significant associations between hs-TnI and overall mortality in the entire study cohort (1: HR 1.17 [1.10–1.25], p<0.001; 2: HR 1.18 [1.11–1.26], p<0.001) and in the non-AMI subgroup (1: HR 1.39 [1.21–1.6], p<0.001; 2: 1.49 [1.28–1.74], p<0.001), but no significant association in the AMI subgroup (1: HR 1.02 [0.91–1.13], p=0.79; 2: 1.03 [0.93–1.3], p=0.55). The addition of hs-TnI to cardiovascular risk factors for the prediction of overall mortality led to a similar increment in the c-index by both hs-TnI assays of 0.014; p=0.034 (1) and 0.015; p=0.037 (2), respectively.
Figure 1. Overall mortality
Conclusion
Hs-TnI assayed on admission is an independent predictor of adverse outcome beyond conventional risk factors in patients presenting to the emergency department with suspected but ruled-out diagnosis of AMI. In patients with the established diagnosis of AMI hs-TnI is not predictive for adverse outcome. Our findings demonstrate the potential role of hs-TnI as a biomarker for risk prediction. Both assessed hs-TnI assays performed equally in predicting adverse events.
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P3858High H2FPEF score is an independent predictor of adverse outcome in patients with severe aortic stenosis and preserved ejection fraction undergoing TAVR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recently, the H2FPEF score has been developed in an evidence-based approach relying on simple clinical and echocardiographic variables. It enables the identification of patients with high probability of prevalent heart failure with preserved ejection fraction (HFpEF) which is associated with a dismal prognosis. Left ventricular diastolic dysfunction, a key mechanism in HFpEF, is also a common finding in patients with severe aortic stenosis.
Objective
To assess the prognostic impact of the H2FPEF score in patients with preserved ejection fraction and severe aortic stenosis undergoing Transcatheter Aortic Valve Replacement (TAVR).
Methods
Among 1148 patients with preserved ejection fraction who received TAVR at our institution between 2013 and 2018, data for calculation of the H2FPEF score was available in 535 patients. Score variables include BMI >30 kg/m2, arterial hypertension, atrial fibrillation, pulmonary hypertension >35 mmHg, age >60 years, and elevated LV filling pressure. Patients were dichotomized according to “low” (1–5 points; n=377) and “high” H2FPEF scores (6–9; n=158). Kaplan-Meier survival curves and Cox regression analyses were used to assess the prognostic impact of H2FPEF scores. Median follow-up time was 0.3 years.
Results
TAVR patients presenting with high H2FPEF scores had higher prevalence of moderate to severe mitral regurgitation (19.4% vs. 33.6%, p<0.001) as well as tricuspid regurgitation (15.2% vs. 35.1%, p<0.001), and presented with lower stroke volume index (42.2 ml/m2 vs. 36.0 ml/m2, p<0.001) compared to those with low H2FPEF scores. All-cause mortality one year after TAVR was significantly higher in patients in the high H2FPEF score group (10.5% vs. 21.0%, p=0.0019, Figure 1). Multivariate analysis revealed a high H2FPEF score to be independently predictive for 1-year all-cause mortality (HR 2.66, 95% CI: 1.41–5.02, p=0.025). Among the single H2FPEF score variables, atrial fibrillation (HR 3.45, 95% CI: 1.86–6.40, p<0.001) and systolic pulmonary hypertension >55 mmHg (HR=2.68, 95% CI: 0.97–7.40, p=0.057) were strong independent predictors of adverse outcome.
Figure 1. All-cause mortality of patients undergoing TAVR after one year stratified by low (1–5 points) and high (6–9) H2FPEF score
Conclusion
An elevated H2FPEF score of >6 is independently predictive for mortality in patients with preserved ejection fraction undergoing TAVR for severe aortic stenosis. Our findings provide evidence that the H2FPEF score, which was meant for diagnostic use originally, is able to serve as a prognostic tool in patients with preserved ejection fraction undergoing TAVR, highlighting the adverse impact of diastolic dysfunction in patients with preserved ejection fraction and aortic stenosis.
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P1848Prevalence and outcomes in patients with Heyde syndrome after transcatheter aortic valve implantation, a single centre experience. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Heyde syndrome is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. To date only few data exist regarding the prevalence of Heyde syndrome and results after transcatheter aortic valve implantation (TAVI) for the treatment of AS.
Purpose
We sought to evaluate the prevalence of Heyde syndrome in a routine clinical cohort of patients undergoing TAVI and analyze the effectiveness of treatment of AS regarding recurrent GIB in these patients.
Methods
We conducted a retrospective single-center analysis of 2545 consecutive patients who underwent TAVI for the treatment of AS in 2008–2017. Patients with a history of GIB were identified. The diagnosis of Heyde syndrome was defined as a clinical triad of presence of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. GIB of unknown origin or related to other causes was defined as bleeding unrelated to angiodysplasia. Clinical outcomes of patients with Heyde syndrome were evaluated with emphasis on bleeding complications and recurrence of GIB.
Results
A history of GIB prior to TAVI was detected in 190 patients (7.5%) of the TAVI cohort. Among them, 143 patients had a GIB unrelated to angiodysplasia (5.6%) and 47 patients (1.8%) were diagnosed with Heyde syndrome. Median age and STS-PROM were 80.7 (75.3, 84.0) years and 4.7 (2.7, 9.0) respectively in Heyde patients. TAVI was successfully performed in all cases (66% endovascular access, 34% transapical access). The effective orifice areas increased from 0.8±0.1 cm2 to 2.1±0.5 cm2. Periprocedural major/life-threatening bleeding was found in 6 patients (12.8%), mainly access-related and none due to GIB. In 51% of Heyde-patients transfusion of 4.5±5.7 packed red blood cells was required during the index hospitalisation. During a mean follow-up of 12 months, recurrent GIB after TAVI was detected in 32% of patients with Heyde syndrome. In contrast only 18% of patients with GIB unrelated to angiodysplasia (Non-Heyde) had recurrent GIB after TAVI. In patients diagnosed with Heyde syndrome and recurrent GIB after TAVI the rate of residual mild or moderate paravalvular regurgitation was higher compared to those with an unremarkable course (73% vs. 37%, p=0.045).
Figure 1. 1-year Follow-Up
Conclusions
A relevant number of patients presenting for treatment of AS can be diagnosed with Heyde syndrome. In these patients TAVI can be successfully performed with moderate incidence of periprocedural bleeding complications but significant transfusion rates. Regardless of successful treatment of AS, recurrent GIB was detected in a significant number of Heyde patients during follow-up. The possible association with residual paravalvular regurgitation requires further investigation to improve treatment options in patients with Heyde syndrome.
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URGE II Studie – randomisierter Vergleich der medikamentösen Standardtherapie mit dem operativen Ersatz der Pubourethralligamente nach vorheriger Level 1 Korrektur zur Behandlung der Urininkontinenz. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Transcatheter Mitral Valve Implantation Using Dedicated Devices: Early Experience Using Different Transapical and Transseptal Devices. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Randomized clinical trial to evaluate the efficacy of prostaglandin F 2α to treat purulent vaginal discharge in lactating dairy cows. J Dairy Sci 2018; 101:11403-11412. [PMID: 30292549 DOI: 10.3168/jds.2018-14765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/23/2018] [Indexed: 09/29/2023]
Abstract
The objectives of this study were (1) to assess the effect of purulent vaginal discharge (PVD) on reproductive performance using a 4-point vaginal discharge score (VDS) and (2) to evaluate the effect of PGF2α treatment in cows with PVD on reproductive performance. Holstein cows (n = 2,473) from 1 commercial dairy farm had their vaginal discharge scored at 32 ± 3 d in milk (DIM) using a 4-point scale. Cows were also scored for body condition score and had their ovaries examined using transrectal ultrasound. A VDS-2 or greater was used to define PVD. Cows with PVD were assigned to receive 2 doses of 500 µg of PGF2α analogue (n = 277; Cloprostenol; PGF Veyx forte, Veyx Pharma Ltd., Schwarzenborn, Germany) 14 d apart (odd ear tag number) or remained untreated (n = 272; even ear tag number). All cows not detected in estrus at 90 ± 3 DIM were enrolled into a timed artificial insemination (AI) protocol. The effect of VDS and the effect of PGF2α in cows with PVD on reproductive performance were evaluated separately. First service conception risk (FSCR), time to first AI, and time to pregnancy were used as indicators for reproductive performance. Data were analyzed with Cox's regression and mixed logistic models. The prevalence of PVD was 22.2% (548/2,473). We detected an interaction of parity and VDS for FSCR and time to pregnancy. In primiparous cows, VDS had no effect on FSCR and time to pregnancy. In multiparous cows, VDS had an effect on FSCR and time to pregnancy. Multiparous cows having a VDS-2 or a VDS-3 had decreased odds of pregnancy at first AI compared with cows having a VDS-0. Multiparous cows with VDS-1 or VDS-3 had a decreased hazard of conceiving within 200 DIM. The treatment effect of PGF2α was conditional on parity. In primiparous animals with PVD without a corpus luteum present at 32 DIM, treatment with PGF2α reduced FSCR. Irrespective of the presence of a corpus luteum, treatment with PGF2α decreased the hazard of conceiving within 200 DIM in primiparous cows. Although multiparous cows with PVD treated with PGF2α had increased odds of pregnancy at first AI, no treatment effect was observed on the hazard of conceiving within 200 DIM. Our results do not support the blanket use of PGF2α as a treatment option in postpartum dairy cows having PVD.
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Women leaders in global health - the importance of gender equality in global health. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Electric compound action potentials (ECAPs) and impedances in an open and closed operative site during cochlear implantation. Cochlear Implants Int 2018; 20:23-30. [PMID: 30350745 DOI: 10.1080/14670100.2018.1534667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In patients undergoing cochlear implantation, intraoperative measures of impedance and electrically evoked compound action potentials (ECAPs) are used to confirm device integrity and electrode array position. However, these electrophysiological parameters have been shown to decrease over time, with a small decrement observable as early as 24 h post implantation and becoming more apparent after 6 months. Whether the intraoperatively measured impedances and ECAPs recorded immediately after electrode insertion versus later in the operation or in an open versus closed operative site vary has not been documented. Such variation in measurement procedure may affect the ultimate operative outcome. PATIENTS AND METHODS Between February and October 2016, 38 patients received a cochlear implant (Cochlear®), with half receiving a CI 522 device and the other half receiving a CI 512 device. These patients were distributed into three groups. In the first (group A; n = 21), the impedance and threshold neural response telemetry (tNRT) measures were taken before (M1) and after cutaneous suture (M2), whereas in the second group (group B; n = 11) they were taken twice in the open operative site, once at the time of electrode insertion (M1) and then again 10 min later (M2). The last group (group C; n = 6) was measured only once after a 10 min waiting time before closing the operative site. RESULTS tNRTs of both group A and B were significantly higher at M1 than measured at M2. The magnitude of change in tNRT did vary significantly by group (P = .027) with group A having a bigger decrease than group B. For impedances there was evidence for a significant difference in M2 between the three groups (P = .012), with group C having significantly higher values compared to group A and B. CONCLUSION Intraoperative tNRT measures change significantly over time, including within the first 10 min of implantation. One underlying etiology of this phenomenon for tNRTs seems to be the condition of the surgical site whereas changes of impedances can be best explained by the 'electrochemical cleaning' theory associated with the first stimulation of the electrode. However, for both impedances and tNRTs there also is an important impact of time as well as of acute perioperative changes in electrical conductivity.
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Randomisierte Studie zum Vergleich der operativen mit der medikamentösen Behandlung der Drang- und Mischinkontinenz (URGE 1 Studie). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Effekte der laparoskopische Cervicosakropexie (LACESA) und Vaginosakropexie (LAVASA) auf Harninkontinenz mit apikalen Prolaps. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Bedeutung und Funktion der Uterosacralligamente – Untersuchungen am Rhesusaffen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Urge II Studie – randomisierter Vergleich der medikamentösen Standardtherapie mit dem operativen Ersatz der Pubourethralligamente nach vorheriger Level 1 Korrektur zur Behandlung der Urininkontinenz. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Effekte der laparoskopischen Cervicosakropexie (LACESA) und Vaginosakropexie (LAVASA) auf Harninkontinenz mit apikalem Prolaps. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Randomisierte Studie zum Vergleich der operativen mit der medikamentösen Behandlung der Drang- und Mischinkontinenz (URGE 1 Studie). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Laparoskopische Cervico-Sacropexie (LACESA) und Vagino-Sacropexie (LAVASA) und der Einfluss auf Mischharninkontinenz (MUI) und Dranginkontinenz (UUI). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Der Abstand des TOT von der Urethra – 3 mm oder 4 mm – hat keinen Einfluss auf das klinische Ergebnis. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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URGE II Studie – randomisierter Vergleich der medikamentösen Standardtherapie mit dem operativen Ersatz der Pubourethralligamente nach vorheriger CESA oder VASA (Level 1 Korrektur) zur Behandlung der Urininkontinenz. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ergebnisse der operativen Behandlung der Mischinkontinenz der Frau in Abhängigkeit der Länge der Urethra. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1655537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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