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Ott G, Schaubelt Y, Lopez Alcaraz JM, Haverkamp W, Strodthoff N. Using explainable AI to investigate electrocardiogram changes during healthy aging-From expert features to raw signals. PLoS One 2024; 19:e0302024. [PMID: 38603660 PMCID: PMC11008906 DOI: 10.1371/journal.pone.0302024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Cardiovascular diseases remain the leading global cause of mortality. Age is an important covariate whose effect is most easily investigated in a healthy cohort to properly distinguish the former from disease-related changes. Traditionally, most of such insights have been drawn from the analysis of electrocardiogram (ECG) feature changes in individuals as they age. However, these features, while informative, may potentially obscure underlying data relationships. In this paper we present the following contributions: (1) We employ a deep-learning model and a tree-based model to analyze ECG data from a robust dataset of healthy individuals across varying ages in both raw signals and ECG feature format. (2) We use explainable AI methods to identify the most discriminative ECG features across age groups.(3) Our analysis with tree-based classifiers reveals age-related declines in inferred breathing rates and identifies notably high SDANN values as indicative of elderly individuals, distinguishing them from younger adults. (4) Furthermore, the deep-learning model underscores the pivotal role of the P-wave in age predictions across all age groups, suggesting potential changes in the distribution of different P-wave types with age. These findings shed new light on age-related ECG changes, offering insights that transcend traditional feature-based approaches.
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Affiliation(s)
- Gabriel Ott
- Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | | | | | | | - Nils Strodthoff
- Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Fröhlich AK, Porthun J, Talha KM, Lena A, Hadzibegovic S, Wilkenshoff U, Sonntag F, Nikolski A, Ramer LV, Zeller T, Keller U, Bullinger L, Anker SD, Haverkamp W, von Haehling S, Doehner W, Rauch U, Skurk C, Cleland JGF, Butler J, Coats AJS, Landmesser U, Karakas M, Anker MS. Association of an impaired GH-IGF-I axis with cardiac wasting in patients with advanced cancer. Clin Res Cardiol 2024:10.1007/s00392-024-02400-x. [PMID: 38587563 DOI: 10.1007/s00392-024-02400-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Growth hormone (GH) resistance is characterized by high GH levels but low levels of insulin-like growth factor-I (IGF-I) and growth hormone binding protein (GHBP) and, for patients with chronic disease, is associated with the development of cachexia. OBJECTIVES We investigated whether GH resistance is associated with changes in left ventricular (LV) mass (cardiac wasting) in patients with cancer. METHODS We measured plasma IGF-I, GH, and GHBP in 159 women and 148 men with cancer (83% stage III/IV). Patients were grouped by tertile of echocardiographic LVmass/height2 (women, < 50, 50-61, > 61 g/m2; men, < 60, 60-74, > 74 g/m2) and by presence of wasting syndrome with unintentional weight loss (BMI < 24 kg/m2 and weight loss ≥ 5% in the prior 12 months). Repeat echocardiograms were obtained usually within 3-6 months for 85 patients. RESULTS Patients in the lowest LVmass/height2 tertile had higher plasma GH (median (IQR) for 1st, 2nd, and 3rd tertile women, 1.8 (0.9-4.2), 0.8 (0.2-2.2), 0.5 (0.3-1.6) ng/mL, p = 0.029; men, 2.1 (0.8-3.2), 0.6 (0.1-1.7), 0.7 (0.2-1.9) ng/mL, p = 0.003). Among women, lower LVmass was associated with higher plasma IGF-I (68 (48-116), 72 (48-95), 49 (35-76) ng/mL, p = 0.007), whereas such association did not exist for men. Patients with lower LVmass had lower log IGF-I/GH ratio (women, 1.60 ± 0.09, 2.02 ± 0.09, 1.88 ± 0.09, p = 0.004; men, 1.64 ± 0.09, 2.14 ± 0.11, 2.04 ± 0.11, p = 0.002). GHBP was not associated with LVmass. Patients with wasting syndrome with unintentional weight loss had higher plasma GH and GHBP, lower log IGF-I/GH ratio, and similar IGF-I. Overall, GHBP correlated inversely with log IGF-I/GH ratio (women, r = - 0.591, p < 0.001; men, r = - 0.575, p < 0.001). Additionally, higher baseline IGF-I was associated with a decline in LVmass during follow-up (r = - 0.318, p = 0.003). CONCLUSION In advanced cancer, reduced LVmass is associated with increased plasma GH and reduced IGF-I/GH ratio, suggesting increasing GH resistance, especially for patients with wasting syndrome with unintentional weight loss. Higher baseline IGF-I was associated with a decrease in relative LVmass during follow-up.
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Affiliation(s)
- Ann-Kathrin Fröhlich
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Jan Porthun
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
- Norwegian University of Science and Technology, Campus Gjøvik, Gjøvik, Norway
| | - Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alessia Lena
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Sara Hadzibegovic
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Ursula Wilkenshoff
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
- Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Frederike Sonntag
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Anja Nikolski
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Luisa Valentina Ramer
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Tanja Zeller
- University Center of Cardiovascular Science, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Clinic for Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research, Partner Site HH/Kiel/HL, Hamburg, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, a partnership between DKFZ and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center, Berlin, Germany
| | - Lars Bullinger
- German Cancer Consortium (DKTK), Partner Site Berlin, a partnership between DKFZ and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | - Stefan D Anker
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology Campus, Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Wilhelm Haverkamp
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology Campus, Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wolfram Doehner
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
- Centre for Stroke Research, Berlin, Charité-Universitätsmedizin, Berlin, Germany
| | - Ursula Rauch
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Carsten Skurk
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Ulf Landmesser
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany
- Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Mahir Karakas
- German Centre for Cardiovascular Research, Partner Site HH/Kiel/HL, Hamburg, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus S Anker
- Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Hindenburgdamm 30, 12200, Berlin, Germany.
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Haverkamp W, Strodthoff N. [Artificial intelligence-enhanced electrocardiography : Will it revolutionize diagnosis and management of our patients?]. Herzschrittmacherther Elektrophysiol 2024:10.1007/s00399-024-00997-0. [PMID: 38361131 DOI: 10.1007/s00399-024-00997-0] [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: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
The use of artificial intelligence (AI) in healthcare has made significant progress in the last 10 years. Many experts believe that utilization of AI technologies, especially deep learning, will bring about drastic changes in how physicians understand, diagnose, and treat diseases. One aspect of this development is AI-enhanced electrocardiography (ECG) analysis. It involves not only optimizing the traditional ECG analysis by the physician and improving the accuracy of automatic interpretation by the ECG device but also introducing entirely new diagnostic options enabled by AI. Examples include assessing left ventricular function, predicting atrial fibrillation, and diagnosing both cardiac and noncardiac conditions. Through AI, the ECG becomes a comprehensive tool for screening, diagnosis, and patient management, potentially revolutionizing clinical practices. This paper provides an overview of the current state of this development, discusses existing limitations, and explores the challenges that may arise for healthcare professionals in this context.
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus, Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Nils Strodthoff
- Department für Versorgungsforschung, Fakultät VI - Medizin und Gesundheitswissenschaften, Abteilung AI4Health, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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Saussele S, La Rosée P, Kiani A, Haverkamp W, Jentsch-Ullrich K, Stegelmann F, Rieger C, Waller CF, Franke GN, Junghanss C, Kirchmair R, Theurl M, le Coutre P. Addendum to the German Consensus Recommendations on Ponatinib in the Treatment of Chronic Myeloid Leukemia. Acta Haematol 2023:1-8. [PMID: 37848002 DOI: 10.1159/000533666] [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: 01/05/2023] [Accepted: 08/15/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Based on the new data from the primary analysis of the OPTIC (Optimizing Ponatinib Treatment in CP-CML) trial on dose optimization of ponatinib in patients with chronic phase (CP)-CML, the German consensus paper on ponatinib published in 2020 (Saussele S et al., Acta Haematol. 2020) has been updated in this addendum. SUMMARY Focus is on the update of efficacy and safety of ponatinib, reflecting the new data set, as well as the update of the benefit-risk assessment and recommendations for ponatinib starting dose in CP-CML - provided that the decision to use ponatinib has already been made. Furthermore, based on OPTIC and additional empirical data, the expert panel collaborated to develop a decision tree for ponatinib dosing, specifically for intolerant and resistant patients. The recommendations on cardiovascular management have also been updated based on the most recent 2021 guidelines of the European Society of Cardiology (ESC) on cardiovascular disease prevention in clinical practice. KEY MESSAGES The OPTIC data confirm the high efficacy of ponatinib in patients with CP-CML and provide the basis for individualized dose adjustment during the course of treatment.
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Affiliation(s)
- Susanne Saussele
- Department of Haematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Paul La Rosée
- Klinik für Innere Medizin II, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany
| | - Alexander Kiani
- Medizinische Klinik IV, Klinikum Bayreuth GmbH, Bayreuth, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | | | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | | | - Cornelius F Waller
- Internal Medicine I, Haematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center and Faculty of Medicine, Freiburg, Germany
| | - Georg-Nikolaus Franke
- Department for Hematology, Cellular Therapies and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Christian Junghanss
- Hematology, Oncology, Palliative Medicine, Department of Medicine, Clinic III, Rostock University Medical Center, Rostock, Germany
| | - Rudolf Kirchmair
- Medical University of Innsbruck, University Hospital of Internal Medicine, Cardiology and Angiology, Innsbruck, Austria
| | - Markus Theurl
- Medical University of Innsbruck, University Hospital of Internal Medicine, Cardiology and Angiology, Innsbruck, Austria
| | - Philipp le Coutre
- Department of Medicine, Hematology and Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Affiliation(s)
- Wilhelm Haverkamp
- Department of Cardiology Campus Virchow Clinic of German Heart Center Charité, Charité—University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jonathan Tennenbaum
- Center for the Philosophy of Science, University of Lisbon, Lisbon, Portugal
| | - Nils Strodthoff
- Department of Health Sciences, School of Medicine and Health Services, Oldenburg University, Oldenburg, Germany
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Haverkamp W, Strodthoff N, Tennenbaum J, Israel C. [Big hype about ChapGPT in medicine : Is it something for rhythmologists? What must be taken into consideration?]. Herzschrittmacherther Elektrophysiol 2023; 34:240-245. [PMID: 37523010 PMCID: PMC10462516 DOI: 10.1007/s00399-023-00960-5] [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: 06/01/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
ChatGPT, a chatbot based on a large language model, is currently attracting much attention. Modern machine learning (ML) architectures enable the program to answer almost any question, to summarize, translate, and even generate its own texts, all in a text-based dialogue with the user. Underlying technologies, summarized under the acronym NLP (natural language processing), go back to the 1960s. In almost all areas including medicine, ChatGPT is raising enormous hopes. It can easily pass medical exams and may be useful in patient care, diagnostic and therapeutic assistance, and medical research. The enthusiasm for this new technology shown even by medical professionals is surprising. Although the system knows much, it does not know everything; not everything it outputs is accurate either. Every output has to be carefully checked by the user for correctness, which is often not easily done since references to sources are lacking. Issues regarding data protection and ethics also arise. Today's language models are not free of bias and systematic distortion. These shortcomings have led to calls for stronger regulation of the use of ChatGPT and an increasing number of similar language models. However, this new technology represents an enormous progress in knowledge processing and dissemination. Numerous scenarios in which ChatGPT can provide assistance are conceivable, including in rhythmology. In the future, it will be crucial to render the models error-free and transparent and to clearly define the rules for their use. Responsible use requires systematic training to improve the digital competence of users, including physicians who use such programs.
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Affiliation(s)
- W Haverkamp
- Abteilung für Kardiologie und Metabolismus, Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | - N Strodthoff
- Department für Versorgungsforschung, Fakultät VI - Medizin und Gesundheitswissenschaften, Abteilung AI4Health, Universität Oldenburg, Oldenburg, Deutschland
| | - J Tennenbaum
- Center for the Philosophy of Science, University of Lisbon, Lisbon, Portugal
| | - C Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie und Nephrologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
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Strodthoff N, Mehari T, Nagel C, Aston PJ, Sundar A, Graff C, Kanters JK, Haverkamp W, Dössel O, Loewe A, Bär M, Schaeffter T. PTB-XL+, a comprehensive electrocardiographic feature dataset. Sci Data 2023; 10:279. [PMID: 37179420 PMCID: PMC10183020 DOI: 10.1038/s41597-023-02153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Machine learning (ML) methods for the analysis of electrocardiography (ECG) data are gaining importance, substantially supported by the release of large public datasets. However, these current datasets miss important derived descriptors such as ECG features that have been devised in the past hundred years and still form the basis of most automatic ECG analysis algorithms and are critical for cardiologists' decision processes. ECG features are available from sophisticated commercial software but are not accessible to the general public. To alleviate this issue, we add ECG features from two leading commercial algorithms and an open-source implementation supplemented by a set of automatic diagnostic statements from a commercial ECG analysis software in preprocessed format. This allows the comparison of ML models trained on clinically versus automatically generated label sets. We provide an extensive technical validation of features and diagnostic statements for ML applications. We believe this release crucially enhances the usability of the PTB-XL dataset as a reference dataset for ML methods in the context of ECG data.
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Affiliation(s)
| | - Temesgen Mehari
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
- Fraunhofer Heinrich Hertz Institute, Berlin, Germany
| | - Claudia Nagel
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Philip J Aston
- National Physical Laboratory, Teddington, UK
- University of Surrey, Guildford, UK
| | | | | | | | | | - Olaf Dössel
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Axel Loewe
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Markus Bär
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt, Berlin, Germany.
- TU Berlin, Berlin, Germany.
- King's College London, London, UK.
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Lena A, Wilkenshoff U, Hadzibegovic S, Porthun J, Rösnick L, Fröhlich AK, Zeller T, Karakas M, Keller U, Ahn J, Bullinger L, Riess H, Rosen SD, Lyon AR, Lüscher TF, Totzeck M, Rassaf T, Burkhoff D, Mehra MR, Bax JJ, Butler J, Edelmann F, Haverkamp W, Anker SD, Packer M, Coats AJS, von Haehling S, Landmesser U, Anker MS. Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer. J Am Coll Cardiol 2023; 81:1569-1586. [PMID: 37076211 DOI: 10.1016/j.jacc.2023.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Body wasting in patients with cancer can affect the heart. OBJECTIVES The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown. METHODS This study prospectively enrolled 300 patients with mostly advanced, active cancer but without significant cardiovascular disease or infection. These patients were compared with 60 healthy control subjects and 60 patients with chronic heart failure (ejection fraction <40%) of similar age and sex distribution. RESULTS Cancer patients presented with lower left ventricular (LV) mass than healthy control subjects or heart failure patients (assessed by transthoracic echocardiography: 177 ± 47 g vs 203 ± 64 g vs 300 ± 71 g, respectively; P < 0.001). LV mass was lowest in cancer patients with cachexia (153 ± 42 g; P < 0.001). Importantly, the presence of low LV mass was independent of previous cardiotoxic anticancer therapy. In 90 cancer patients with a second echocardiogram after 122 ± 71 days, LV mass had declined by 9.3% ± 1.4% (P < 0.001). In cancer patients with cardiac wasting during follow-up, stroke volume decreased (P < 0.001) and resting heart rate increased over time (P = 0.001). During follow-up of on average 16 months, 149 patients died (1-year all-cause mortality 43%; 95% CI: 37%-49%). LV mass and LV mass adjusted for height squared were independent prognostic markers (both P < 0.05). Adjustment of LV mass for body surface area masked the observed survival impact. LV mass below the prognostically relevant cutpoints in cancer was associated with reduced overall functional status and lower physical performance. CONCLUSIONS Low LV mass is associated with poor functional status and increased all-cause mortality in cancer. These findings provide clinical evidence of cardiac wasting-associated cardiomyopathy in cancer.
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Affiliation(s)
- Alessia Lena
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Ursula Wilkenshoff
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Sara Hadzibegovic
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Jan Porthun
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany; Norwegian University of Science and Technology, Campus Gjøvik, Gjøvik, Norway
| | - Lukas Rösnick
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Ann-Kathrin Fröhlich
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Tanja Zeller
- University Center of Cardiovascular Science, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Clinic for Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research, partner site HH/Kiel/HL, Hamburg, Germany
| | - Mahir Karakas
- German Centre for Cardiovascular Research, partner site HH/Kiel/HL, Hamburg, Germany; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Charité - University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany; German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany; Max Delbrück Center, Berlin, Germany
| | - Johann Ahn
- Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | - Lars Bullinger
- German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany; Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | - Hanno Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité - University Medicine Berlin, Campus CCM, Berlin, Germany
| | - Stuart D Rosen
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Heart Division, Royal Brompton & Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Thomas F Lüscher
- Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Heart Division, Royal Brompton & Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | | | - Mandeep R Mehra
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Turku University, Turku, Finland
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Frank Edelmann
- Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany
| | - Wilhelm Haverkamp
- German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology Campus Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Stefan D Anker
- German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany; Department of Cardiology Campus Virchow Clinic of German Heart Center Charité, Charité - University Medicine Berlin, Berlin, Germany
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; German Centre for Cardiovascular Research, partner site Göttingen, Göttingen, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Markus S Anker
- Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.
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9
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Haverkamp W, Sittner W, Haverkamp A, Knebel F. [Alternative treatment strategies for atrial fibrillation : Benefits from yoga?]. Herzschrittmacherther Elektrophysiol 2023; 34:59-65. [PMID: 36580092 PMCID: PMC9798365 DOI: 10.1007/s00399-022-00915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Atrial fibrillation, the most common sustained cardiac arrhythmia, is associated with significant morbidity, mortality, and healthcare utilization. Since the procedures used to treat atrial fibrillation have a number of limitations and risks, there is a growing interest in alternative treatment strategies for patients with atrial fibrillation. One such option is yoga. To date, only a few studies are available on its effect on atrial fibrillation. However, these suggest that yoga may indeed be able to reduce the frequency of the arrhythmia and its progression. The risk factors for atrial fibrillation and quality of life in affected patients are also positively affected. As adverse effects and complications are extremely rare with competent guidance, yoga may already be recommended now. However, further clinical studies are needed to provide recommendations that meet evidence-based criteria.
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus, Med. Klinik für Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
- Klinik für Innere Medizin II: Schwerpunkt Kardiologie, Sana Klinikum Lichtenberg, Berlin, Deutschland.
- Kardiologie im Spreebogen, Berlin, Deutschland.
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | | | - Annika Haverkamp
- Fakultät für Medizin, Universität Regensburg, Regensburg, Deutschland
| | - Fabian Knebel
- Klinik für Innere Medizin II: Schwerpunkt Kardiologie, Sana Klinikum Lichtenberg, Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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10
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Haverkamp W, Strodthoff N, Israel C. [Erratum to: Artificial intelligence-based ECG analysis: current status and future perspectives-Part 2 : Recent studies and future]. Herzschrittmacherther Elektrophysiol 2022; 33:360. [PMID: 35652969 PMCID: PMC9411228 DOI: 10.1007/s00399-022-00871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus. Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | - Nils Strodthoff
- Department für Versorgungsforschung, Fakultät VI - Medizin und Gesundheitswissenschaften, Universität Oldenburg, Oldenburg, Deutschland
| | - Carsten Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie und Nephrologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
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11
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Doldi F, Plagwitz L, Hoffmann LP, Rath B, Frommeyer G, Reinke F, Leitz P, Büscher A, Güner F, Brix T, Wegner FK, Willy K, Hanel Y, Dittmann S, Haverkamp W, Schulze-Bahr E, Varghese J, Eckardt L. Detection of Patients with Congenital and Often Concealed Long-QT Syndrome by Novel Deep Learning Models. J Pers Med 2022; 12:jpm12071135. [PMID: 35887632 PMCID: PMC9323528 DOI: 10.3390/jpm12071135] [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: 06/23/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The long-QT syndrome (LQTS) is the most common ion channelopathy, typically presenting with a prolonged QT interval and clinical symptoms such as syncope or sudden cardiac death. Patients may present with a concealed phenotype making the diagnosis challenging. Correctly diagnosing at-risk patients is pivotal to starting early preventive treatment. Objective: Identification of congenital and often concealed LQTS by utilizing novel deep learning network architectures, which are specifically designed for multichannel time series and therefore particularly suitable for ECG data. Design and Results: A retrospective artificial intelligence (AI)-based analysis was performed using a 12-lead ECG of genetically confirmed LQTS (n = 124), including 41 patients with a concealed LQTS (33%), and validated against a control cohort (n = 161 of patients) without known LQTS or without QT-prolonging drug treatment but any other cardiovascular disease. The performance of a fully convolutional network (FCN) used in prior studies was compared with a different, novel convolutional neural network model (XceptionTime). We found that the XceptionTime model was able to achieve a higher balanced accuracy score (91.8%) than the associated FCN metric (83.6%), indicating improved prediction possibilities of novel AI architectures. The predictive accuracy prevailed independently of age and QTc parameters. Conclusions: In this study, the XceptionTime model outperformed the FCN model for LQTS patients with even better results than in prior studies. Even when a patient cohort with cardiovascular comorbidities is used. AI-based ECG analysis is a promising step for correct LQTS patient identification, especially if common diagnostic measures might be misleading.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
- Correspondence: ; Tel.: +49-251-8344633
| | - Lucas Plagwitz
- Institute of Medical Informatics, University of Münster, 48149 Münster, Germany; (L.P.); (T.B.); (J.V.)
| | - Lea Philine Hoffmann
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Benjamin Rath
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Gerrit Frommeyer
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Florian Reinke
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Patrick Leitz
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Antonius Büscher
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Fatih Güner
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Tobias Brix
- Institute of Medical Informatics, University of Münster, 48149 Münster, Germany; (L.P.); (T.B.); (J.V.)
| | - Felix Konrad Wegner
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Kevin Willy
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
| | - Yvonne Hanel
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster, 48149 Münster, Germany; (Y.H.); (S.D.); (E.S.-B.)
| | - Sven Dittmann
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster, 48149 Münster, Germany; (Y.H.); (S.D.); (E.S.-B.)
| | - Wilhelm Haverkamp
- Department of Internal Medicine and Cardiology, Charité University Medicine, 10117 Berlin, Germany;
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster, 48149 Münster, Germany; (Y.H.); (S.D.); (E.S.-B.)
| | - Julian Varghese
- Institute of Medical Informatics, University of Münster, 48149 Münster, Germany; (L.P.); (T.B.); (J.V.)
| | - Lars Eckardt
- Department for Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany; (L.P.H.); (B.R.); (G.F.); (F.R.); (P.L.); (A.B.); (F.G.); (F.K.W.); (K.W.); (L.E.)
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12
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Haverkamp W, Strodthoff N, Israel C. [Artificial intelligence-based ECG analysis: current status and future perspectives-Part 1 : Basic principles]. Herzschrittmacherther Elektrophysiol 2022; 33:232-240. [PMID: 35552486 PMCID: PMC9177483 DOI: 10.1007/s00399-022-00854-y] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
Even though electrocardiography is a diagnostic procedure that is now more than 100 years old, medicine cannot do without it. On the contrary, interest in the procedure and its clinical significance is even increasing again. Reports on the evaluation of electrocardiograms (ECGs) with the aid of artificial intelligence (AI) are also responsible for this. Using machine learning and in particular deep learning, both AI subfields, completely new perspectives of ECG evaluation and interpretation arise. The weaknesses inherent in classical computer-assisted ECG evaluation appear to be overcome. This two-part overview deals with AI-based ECG analysis. Part 1 introduces basic aspects of the procedure. Part 2, which is published separately, is devoted to the current state of research and discusses the available studies. In addition, possible scenarios of future application of AI in ECG analysis are discussed.
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus, Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | - Nils Strodthoff
- Department für Versorgungsforschung, Fakultät VI - Medizin und Gesundheitswissenschaften, Universität Oldenburg, Oldenburg, Deutschland
| | - Carsten Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie und Nephrologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
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13
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Haverkamp W, Strodthoff N, Israel C. [Erratum to: Artificial intelligence-based ECG analysis: current status and future perspectives-Part 1 : Basic principles]. Herzschrittmacherther Elektrophysiol 2022; 33:241. [PMID: 35639155 PMCID: PMC9177470 DOI: 10.1007/s00399-022-00870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus, Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | - Nils Strodthoff
- Department für Versorgungsforschung, Fakultät VI - Medizin und Gesundheitswissenschaften, Universität Oldenburg, Oldenburg, Deutschland
| | - Carsten Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie und Nephrologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
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14
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Haverkamp W, Strodthoff N, Israel C. [Artificial intelligence-based ECG analysis: current status and future perspectives : Part 2: Recent studies and future]. Herzschrittmacherther Elektrophysiol 2022; 33:305-311. [PMID: 35552487 PMCID: PMC9411078 DOI: 10.1007/s00399-022-00855-x] [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: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
Während grundlegende Aspekte der Anwendung von künstlicher Intelligenz (KI) zur Elektrokardiogramm(EKG)-Analyse in Teil 1 dieser Übersicht behandelt wurden, beschäftigt sich die vorliegende Arbeit (Teil 2) mit einer Besprechung von aktuellen Studien zum praktischen Einsatz dieser neuen Technologien und Aspekte ihrer aktuellen und möglichen zukünftigen Anwendung. Die Anzahl der zum Thema KI-basierte EKG-Analyse publizierten Studien steigt seit 2017 rasant an. Dies gilt vor allem für Untersuchungen, die Deep Learning (DL) mit künstlichen neuronalen Netzen (KNN) einsetzen. Inhaltlich geht es nicht nur darum, die Schwächen der klassischen EKG-Diagnostik mit Hilfe von KI zu überwinden und die diagnostische Güte des Verfahrens zu verbessern, sondern auch die Funktionalität des EKGs zu erweitern. Angestrebt wird die Erkennung spezieller kardiologischer und nichtkardiologischer Krankheitsbilder sowie die Vorhersage zukünftiger Krankheitszustände, z. B. die zukünftige Entwicklung einer linksventrikulären Dysfunktion oder das zukünftige Auftreten von Vorhofflimmern. Möglich wird dies, indem KI mittels DL in riesigen EKG-Datensätzen subklinische Muster findet und für die Algorithmen-Entwicklung nutzt. Die KI-unterstützte EKG-Analyse wird somit zu einem Screening-Instrument und geht weit darüber hinaus, nur besser als ein Kardiologe zu sein. Die erzielten Fortschritte sind bemerkenswert und sorgen in Fachwelt und Öffentlichkeit für Aufmerksamkeit und Euphorie. Bei den meisten Studien handelt es sich allerdings um Proof-of-Concept-Studien. Häufig werden private (institutionseigene) Daten verwendet, deren Qualität unklar ist. Bislang ist nur selten eine klinische Validierung der entwickelten Algorithmen in anderen Kollektiven und Szenarien erfolgt. Besonders problematisch ist, dass der Weg, wie KI eine Lösung findet, bislang meistens verborgen bleibt (Blackbox-Charakter). Damit steckt die KI-basierte Elektrokardiographie noch in den Kinderschuhen. Unbestritten ist aber schon absehbar, dass das EKG als einfach anzuwendendes und beliebig oft wiederholbares diagnostisches Verfahren auch in Zukunft nicht nur weiterhin unverzichtbar sein wird, sondern durch KI an klinischer Bedeutung gewinnen wird.
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus. Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | - Nils Strodthoff
- Department für Versorgungsforschung, Fakultät VI - Medizin und Gesundheitswissenschaften, Universität Oldenburg, Oldenburg, Deutschland
| | - Carsten Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie und Nephrologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
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15
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Gray B, Baruteau AE, Antolin AA, Pittman A, Sarganas G, Molokhia M, Blom MT, Bastiaenen R, Bardai A, Priori SG, Napolitano C, Weeke PE, Shakir SA, Haverkamp W, Mestres J, Winkel BG, Witney AA, Chis-Ster I, Sangaralingam A, Camm AJ, Tfelt-Hansen J, Roden DM, Tan HL, Garbe E, Sturkenboom M, Behr ER. Rare Variation in Drug Metabolism and Long QT Genes and the Genetic Susceptibility to Acquired Long QT Syndrome. Circ Genom Precis Med 2022; 15:e003391. [PMID: 35113648 DOI: 10.1161/circgen.121.003391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acquired long QT syndrome (aLQTS) is a serious unpredictable adverse drug reaction. Pharmacogenomic markers may predict risk. METHODS Among 153 aLQTS patients (mean age 58 years [range, 14-88], 98.7% White, 85.6% symptomatic), computational methods identified proteins interacting most significantly with 216 QT-prolonging drugs. All cases underwent sequencing of 31 candidate genes arising from this analysis or associating with congenital LQTS. Variants were filtered using a minor allele frequency <1% and classified for susceptibility for aLQTS. Gene-burden analyses were then performed comparing the primary cohort to control exomes (n=452) and an independent replication aLQTS exome sequencing cohort. RESULTS In 25.5% of cases, at least one rare variant was identified: 22.2% of cases carried a rare variant in a gene associated with congenital LQTS, and in 4% of cases that variant was known to be pathogenic or likely pathogenic for congenital LQTS; 7.8% cases carried a cytochrome-P450 (CYP) gene variant. Of 12 identified CYP variants, 11 (92%) were in an enzyme known to metabolize at least one culprit drug to which the subject had been exposed. Drug-drug interactions that affected culprit drug metabolism were found in 19% of cases. More than one congenital LQTS variant, CYP gene variant, or drug interaction was present in 7.8% of cases. Gene-burden analyses of the primary cohort compared to control exomes (n=452), and an independent replication aLQTS exome sequencing cohort (n=67) and drug-tolerant controls (n=148) demonstrated an increased burden of rare (minor allele frequency<0.01) variants in CYP genes but not LQTS genes. CONCLUSIONS Rare susceptibility variants in CYP genes are emerging as potentially important pharmacogenomic risk markers for aLQTS and could form part of personalized medicine approaches in the future.
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Affiliation(s)
- Belinda Gray
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Alban-Elouen Baruteau
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France (A.-E.B.)
| | - Albert A Antolin
- Systems Pharmacology, Research Program on Biomedical Informatics (GRIB), IMIM Hospital del Mar Medical Research Institute & University Pompeu Fabra, Parc de Recerca Biomedica, Barcelona, Catalonia, Spain (A.A.A., M.J.M.)
| | - Alan Pittman
- Genetics Research Centre (A.P.), St George's University of London, United Kingdom
| | - Giselle Sarganas
- Clinical Pharmacology & Toxicology, Charite Universitaetsmedizin, Berlin, Germany (G.S.)
| | - Mariam Molokhia
- Department of Population Health Sciences, King's College London, United Kingdom (M.M.)
| | - Marieke T Blom
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Abdenasser Bardai
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Silvia G Priori
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy (S.G.P., C.N.)
- Department of Molecular Medicine, University of Pavia, Italy (S.G.P., C.N.)
| | - Carlo Napolitano
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy (S.G.P., C.N.)
- Department of Molecular Medicine, University of Pavia, Italy (S.G.P., C.N.)
| | - Peter E Weeke
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France (A.-E.B.)
- Departments of Medicine, Pharmacology & Biomedical Informatics Vanderbilt University Medical Centre (P.E.W., D.M.R.)
| | - Saad A Shakir
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, United Kingdom (S.A.S.)
- Associate Department of the School of Pharmacy & Biomedical Sciences, University of Portsmouth, United Kingdom (S.A.S.)
| | - Wilhelm Haverkamp
- Charité-Campus Virchow-Klinikum (CVK), Department of Cardiology, Berlin, Germany (W.H.)
| | - Jordi Mestres
- Systems Pharmacology, Research Program on Biomedical Informatics (GRIB), IMIM Hospital del Mar Medical Research Institute & University Pompeu Fabra, Parc de Recerca Biomedica, Barcelona, Catalonia, Spain (A.A.A., M.J.M.)
| | - Bo Gregers Winkel
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (B.W., J.T.-H.)
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (P.E.W., B.W., J.T.-H.)
| | - Adam A Witney
- Institute of Infection & Immunity (A.A.W., I.C.-S.), St George's University of London, United Kingdom
| | - Irina Chis-Ster
- Institute of Infection & Immunity (A.A.W., I.C.-S.), St George's University of London, United Kingdom
| | - Ajanthah Sangaralingam
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (P.E.W., B.W., J.T.-H.)
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (B.W., J.T.-H.)
| | - Dan M Roden
- Departments of Medicine, Pharmacology & Biomedical Informatics Vanderbilt University Medical Centre (P.E.W., D.M.R.)
| | - Hanno L Tan
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Edeltraut Garbe
- Leibniz Institute for Prevention Research & Epidemiology - BIPS, Bremen, Germany (E.G.)
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht, the Netherlands (M.S.)
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
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16
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Sanchez-Somonte P, Jiang CY, Betts TR, Chen J, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P, Verma A. Completeness of Linear or Fractionated Electrogram Ablation in Addition to Pulmonary Vein Isolation on Ablation Outcome: A Substudy of the STAR AF II Trial. Circ Arrhythm Electrophysiol 2021; 14:e010146. [PMID: 34488431 DOI: 10.1161/circep.121.010146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Chen-Yang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China (C.-y.J.)
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals, John Radcliffe Hospital, Oxford, United Kingdom (T.R.B.)
| | - Jian Chen
- Department of Cardiology, Haukeland University Hospital, University of Bergen, Norway (J.C.)
| | - Roberto Mantovan
- Department of Cardiology, Ospedale S. Maria di Ca' Foncelli, Treviso, Italy (R.M.)
| | - Laurent Macle
- Department of Cardiology, Montreal Heart Institute (L.M.)
| | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Canada (C.A.M.)
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany (W.H.)
| | - Rukshen Weerasooriya
- Department of Cardiology, Hollywood Private Hospital, Nedlands, Western Australia, Australia, University of Western Australia, Crawley (R.W.)
| | | | - Stefano Nardi
- Department of Cardiology, Pineta Grande Hospital, Castel Volturno (S.N.)
| | - Endrj Menardi
- Department of Cardiology, Ospedale Santa Croce e Carle, Cuneo, Italy (E.M.)
| | - Paul Novak
- Department of Cardiology, Royal Jubilee Hospital, Victoria, Canada (P.N.)
| | - Prashanthan Sanders
- Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide & Royal Adelaide Hospital, Australia (P.S.)
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Canada (P.S.-S., A.V.)
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17
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Anker MS, von Haehling S, Coats AJS, Riess H, Eucker J, Porthun J, Butler J, Karakas M, Haverkamp W, Landmesser U, Anker SD. Ventricular tachycardia, premature ventricular contractions, and mortality in unselected patients with lung, colon, or pancreatic cancer: a prospective study. Eur J Heart Fail 2021; 23:145-153. [PMID: 33222388 DOI: 10.1002/ejhf.2059] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Many cancer patients die due to cardiovascular disease and sudden death, but data on ventricular arrhythmia prevalence and prognostic importance are not known. METHODS AND RESULTS Between 2005 and 2010, we prospectively enrolled 120 unselected patients with lung, colon, or pancreatic cancer due to one of three diagnoses: colorectal (n = 33), pancreatic (n = 54), or non-small cell lung cancer (n = 33). All were free of manifest cardiovascular disease. They were compared to 43 healthy controls similar in age and sex distribution. Each participant underwent 24 h electrocardiogram recording and cancer patients were followed for up to 12.5 years for survival (median 21 months). Ninety-six cancer patients (80%) died during follow-up [5-year survival: 27% (95% confidence interval 19-35%)]. Non-sustained ventricular tachycardia (NSVT) was more frequent in cancer patients vs. controls (8% vs. 0%, P = 0.021). The number of premature ventricular contractions (PVCs) over 24 h was not increased in cancer patients vs. controls (median 4 vs. 9, P = 0.2). In multivariable analysis, NSVT [hazard ratio (HR) 2.44, P = 0.047] and PVCs (per 100, HR 1.021, P = 0.047) were both significant predictors of mortality, independent of other univariable mortality predictors including tumour stage, cancer type, potassium concentration, prior surgery, prior cardiotoxic chemotherapy, and haemoglobin. In patients with colorectal and pancreatic cancer, ≥50 PVCs/24 h predicted mortality (HR 2.30, P = 0.0024), and was identified in 18% and 26% of patients, respectively. CONCLUSIONS Non-sustained ventricular tachycardia is more frequent in unselected patients with colorectal, pancreatic, and non-small cell lung cancer and together with PVCs predict long-term mortality. This raises the prospect of cardiovascular mortality being a target for future treatment interventions in selected cancers.
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Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany.,Department of Cardiology (CBF), Charité University Medicine Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | | | - Hanno Riess
- Department of Hematology and Oncology, Charité - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - Jan Eucker
- Department of Hematology and Oncology, Benjamin Franklin Campus, Charité University of Medicine Berlin, Berlin, Germany
| | - Jan Porthun
- Norwegian University of Science and Technology, Campus Gjøvik (NTNU-Gjøvik), Norway
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackons, MS, USA
| | - Mahir Karakas
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Center for Cardiovascular Research, Hamburg, Germany
| | - Wilhelm Haverkamp
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité University Medicine Berlin, Berlin, Germany
| | - Ulf Landmesser
- German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany.,Department of Cardiology (CBF), Charité University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité University Medicine Berlin, Berlin, Germany
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18
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Haverkamp W, Butler J, Anker SD. Can we trust a smartwatch ECG? Potential and limitations. Eur J Heart Fail 2021; 23:850-853. [PMID: 33880842 DOI: 10.1002/ejhf.2194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Wilhelm Haverkamp
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
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19
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus, Med. Klinik für Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | - Olaf Göing
- Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - Markus Anker
- Abteilung für Kardiologie und Metabolismus, Med. Klinik für Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland
| | - Stefan D Anker
- Abteilung für Kardiologie und Metabolismus, Med. Klinik für Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland
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20
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Conti S, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P, Verma A. Incidence of Concurrent Atrial Fibrillation in Patients Who Present With Atrial Tachycardia and Atrial Flutter Postablation for Persistent Atrial Fibrillation: Insights From the STAR AF II Trial. Circ Arrhythm Electrophysiol 2021; 14:e008683. [PMID: 33657834 DOI: 10.1161/circep.120.008683] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sergio Conti
- Department of Cardiology, Southlake Regional Health Centre, Newmarket, ON, Canada (S.C., A.V.).,Department of Cardiology, University of Tor Vergata, Rome, Italy (S.C.)
| | - Chen-Yang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China (C.-y.J.)
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals, John Radcliffe Hospital, United Kingdom (T.R.B.)
| | - Jian Chen
- Department of Cardiology, Haukeland University Hospital, University of Bergen, Norway (J.C.)
| | | | - Roberto Mantovan
- Department of Cardiology, Ospedale S. Maria di Ca' Foncelli, Treviso, Italy (R.M.)
| | | | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AL, Canada (C.A.M.)
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany (W.H.)
| | - Rukshen Weerasooriya
- Department of Cardiology, Hollywood Private Hospital, Nedlands, Western Australia (R.W.).,Department of Cardiology, University of Western Australia, Crawley (R.W.)
| | | | - Stefano Nardi
- Department of Cardiology, Pineta Grande Hospital, Castel Volturno, Italy (S.N.)
| | - Endrj Menardi
- Department of Cardiology, Ospedale Santa Croce e Carle, Cuneo, Italy (E.M.)
| | - Paul Novak
- Department of Cardiology, Royal Jubilee Hospital, Victoria, BC, Canada (P.N.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia (P.S.)
| | - Atul Verma
- Department of Cardiology, Southlake Regional Health Centre, Newmarket, ON, Canada (S.C., A.V.).,Department of Cardiology, University of Toronto, ON, Canada (A.V.)
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21
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Haverkamp W. Therapie von Herzrhythmusstörungen mit Antiarrhythmika: kein Ende einer Ära. Aktuelle Kardiologie 2020. [DOI: 10.1055/a-1278-9766] [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: 10/22/2022]
Abstract
ZusammenfassungAntiarrhythmika sind eine Medikamentengruppe, die vor mehr als 100 Jahren eingeführt wurde. Jahrzehntelang wurden sie relativ breit und großzügig eingesetzt. Die Erkenntnis, dass proarrhythmische Effekte relativ häufig sind, und die Entwicklung neuer nicht medikamentöser Behandlungsalternativen (z. B. die Katheterablation bei Vorhofflimmern) haben dazu geführt, dass sich ihr klinischer Stellenwert in den letzten Jahren geändert hat. Schon seit Längerem wird das Ende der Antiarrhythmikaära prophezeit. In der Realität ergibt sich allerdings ein anderes Bild. Registerdaten zeigen, dass fast die Hälfte der Patienten mit Vorhofflimmern, die sich einer Katheterablation unterziehen, im weiteren Verlauf ein Antiarrhythmikum erhält. Eine unverändert wichtige Rolle spielen Antiarrhythmika (insbesondere Amiodaron) auch im Notfall und bei Patienten mit häufigen malignen ventrikulären Arrhythmien. Einen zunehmend relevanter werdenden Anwendungsbereich stellen angeborene Arrhythmien
(langes-QT-Syndrom, Brugada-Syndrom, katecholaminerge polymorphe Kammertachykardien) dar. Antiarrhythmika gehören damit weiterhin zum Armamentarium des rhythmologisch orientierten Arztes. Es darf gehofft werden, dass neue Formen des EKG- und Patienten-Monitorings (z. B. Smartphone-EKGs) dazu betragen werden, die Überprüfung der Therapiewirksamkeit zu vereinfachen und die Therapiesicherheit zu optimieren.
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie u. Metabolismus, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Deutschland
- Kardiologie im Spreebogen, Berlin, Deutschland
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22
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Beer K, Kuhlmann SL, Tschorn M, Arolt V, Grosse L, Haverkamp W, Waltenberger J, Strehle J, Martus P, Müller-Nordhorn J, Rieckmann N, Ströhle A. Anxiety disorders and post-traumatic stress disorder in patients with coronary heart disease. Journal of Affective Disorders Reports 2020. [DOI: 10.1016/j.jadr.2020.100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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23
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Warnke K, Brandt J, Jörgens S, Arolt V, Beer K, Domschke K, Haverkamp W, Kuhlmann SL, Müller-Nordhorn J, Rieckmann N, Schwarte K, Ströhle A, Tschorn M, Waltenberger J, Grosse L. Association of 5-HTTLPR/rs25531 with depressive symptoms in patients with coronary heart disease: A prospective study. J Affect Disord 2020; 277:531-539. [PMID: 32889377 DOI: 10.1016/j.jad.2020.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/06/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND 5-HTTLPR/rs25531 is suspected to be involved in the pathogenesis of both coronary heart disease (CHD)1 and depression. We aimed to investigate the role of 5-HTTLPR/rs25531 in the development of depressive symptoms among CHD patients in a longitudinal design. METHODS N = 265 participants with CHD diagnosis were included while hospitalized in a department of cardiology and genotyped for the 5-HTTLPR/rs25531. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9)7 at baseline and after 6 and 12 months. Binary logistic regression models were used to analyze the association of 5-HTTLPR/rs25531 with the prevalence of depressive symptoms at each time point as well as with the incidence and persistence of depressive symptoms at follow-up. RESULTS "LALA" genotype was associated with a higher prevalence of depressive symptoms 12 months after study inclusion. "LALA" genotype was associated with a higher incidence of depressive symptoms 6 and 12 months after study inclusion. There was no association of 5-HTTLPR/rs25531 with the persistence of depressive symptoms. LIMITATIONS Inclusion criteria did not demand a particular cardiac event at baseline, which aggravated the interpretation of the time-specific results. The majority of the participants was of male gender which could cause bias. The present study only vaguely differentiated between ethnical groups which might cause bias regarding nationality-dependent allele distributions. CONCLUSION The present study suggests a time-dependent association of the "LALA" genotype with depressive symptoms in CHD patients. 5-HTTLPR/rs25531 might be an important marker to detect risk groups for later onset depressive symptoms among CHD patients.
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Affiliation(s)
- Katharina Warnke
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Germany.
| | - Julia Brandt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Germany
| | - Silke Jörgens
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Germany
| | - Katja Beer
- Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Wilhelm Haverkamp
- Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Internal Medicine and Cardiology, Berlin, Germany
| | - Stella L Kuhlmann
- Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Division of Emergency and Acute Medicine (CVK, CCM), Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Institute of Public Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Institute of Public Health, Berlin, Germany; Bavarian Food and Health Safety Authority, Oberschleißheim, Germany
| | - Nina Rieckmann
- Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Institute of Public Health, Berlin, Germany
| | - Kathrin Schwarte
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Germany
| | - Andreas Ströhle
- Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Mira Tschorn
- Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany; Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | | | - Laura Grosse
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Germany; Intercultural Business Psychology, Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
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24
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Terricabras M, Mantovan R, Jiang CY, Betts TR, Chen J, Deisenhofer I, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P, Verma A. Association Between Quality of Life and Procedural Outcome After Catheter Ablation for Atrial Fibrillation: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2025473. [PMID: 33275151 PMCID: PMC7718606 DOI: 10.1001/jamanetworkopen.2020.25473] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE Catheter ablation is effective in reducing atrial fibrillation (AF), but the association of ablation for AF with quality of life is unclear. OBJECTIVE To evaluate whether the procedural outcome of ablation for AF is associated with quality of life (QOL) measures. DESIGN, SETTING, AND PARTICIPANTS This was a prespecified secondary analysis of the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation-Part II (STAR AF II) prospective randomized clinical trial, which compared 3 strategies for ablation of persistent AF. This analysis included 549 of the 589 patients enrolled in the trial who underwent ablation. Enrollment occurred at 35 centers in Europe, Canada, Australia, China, and Korea from November 2010 to July 2012. Data for the current study were analyzed on December 11, 2019. INTERVENTIONS Patients underwent AF ablation with 1 of 3 ablation strategies: (1) pulmonary vein isolation (PVI), (2) PVI plus complex fractionated electrograms, or (3) PVI plus linear lesions. MAIN OUTCOMES AND MEASURES Quality of life was assessed at baseline and at 6, 12, and 18 months after ablation for AF using the 36-Item Short Form Health Survey and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire. Scores were also converted to a physical health component score (PCS) and a mental health component score (MCS). Individual AF burden was calculated by the total time with AF from Holter monitors and the percentage of transtelephonic monitor recordings showing AF. RESULTS Among the 549 patients included in this secondary analysis, QOL was assessed in 466 (85%) at baseline and at 6, 12, and 18 months after ablation for AF. The mean (SD) age of the study population was 60 (9) years; 434 (79%) individuals were men, and 417 (76%) had continuous AF for 6 months or more before ablation. The AF burden significantly decreased from a mean (SD) of 82% (36%) before ablation to 6.6% (23%) after ablation (P < .001). Significant improvements in mean (SD) PCS (68.3 [20.7] to 82.5 [18.6]) and MCS (35.3 [8.6] to 37.5 [7.6]) occurred 18 months after ablation (P < .05 for both). Significant QOL improvement occurred in all 3 study arms and regardless of AF recurrence, defined as AF episodes lasting more than 30 seconds: for no recurrence, mean (SD) PCS increased from 66.5 (20.9) to 79.1 (19.4) and MCS from 35.3 (8.7) to 37.7 (7.7); for recurrence, mean (SD) PCS increased from 70.2 (20.4) to 86.4 (16.8) and MCS from 35.3 (8.6) to 37.1 (7.4) (P < .05 for all). When outcome was defined by AF burden reduction, in patients with less than 70% reduction in AF burden, the increase in PCS was significantly less than in those with greater than 70% reduction, and only 3 of 8 subscales showed significant improvement. CONCLUSIONS AND RELEVANCE In this secondary analysis, decreases in AF burden after ablation for AF were significantly associated with improvements in QOL. Quality of life changes were significantly associated with the percentage of AF burden reduction after ablation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01203748.
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Affiliation(s)
- Maria Terricabras
- Department of Cardiology, Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
| | - Roberto Mantovan
- Department of Cardiology, Santa Maria dei Battuti Hospital, Conegliano, Italy
| | - Chen-yang Jiang
- Department of Cardiology, Sir Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Timothy R. Betts
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jian Chen
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Carlos A. Morillo
- Department of Cardiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Wilhelm Haverkamp
- Department of Cardiology, Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Rukshen Weerasooriya
- Department of Cardiology, Hollywood Private Hospital, Perth, Western Australia, Australia
| | | | - Stefano Nardi
- Department of Cardiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Endrj Menardi
- Department of Cardiology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Paul Novak
- Department of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Atul Verma
- Department of Cardiology, Southlake Regional Health Centre, University of Toronto, Newmarket, Ontario, Canada
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25
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Rüger AM, Schneeweiss A, Seiler S, Tesch H, van Mackelenbergh M, Marmé F, Lübbe K, Sinn B, Karn T, Stickeler E, Müller V, Schem C, Denkert C, Fasching PA, Nekljudova V, Garfias‐Macedo T, Hasenfuß G, Haverkamp W, Loibl S, von Haehling S. Cardiotoxicity and Cardiovascular Biomarkers in Patients With Breast Cancer: Data From the GeparOcto-GBG 84 Trial. J Am Heart Assoc 2020; 9:e018143. [PMID: 33191846 PMCID: PMC7763783 DOI: 10.1161/jaha.120.018143] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022]
Abstract
Background Patients with breast cancer can be affected by cardiotoxic reactions through cancer therapies. Cardiac biomarkers, like NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cardiac troponin T, might have predictive value. Methods and Results Echocardiography, ECG, hemodynamic parameters, NT-proBNP and high-sensitivity cardiac troponin T were assessed in 853 patients with early-stage breast cancer randomized in the German Breast Group GeparOcto-GBG 84 phase III trial. Patients received neo-adjuvant dose-dense, dose-intensified epirubicin, paclitaxel, and cyclophosphamide (iddEPC group, n=424) or paclitaxel, non-pegylated doxorubicin, and in triple negative breast cancer, (paclitaxel, non-pegylated doxorubicin, carboplatin group, n=429) treatment for 18 weeks. Patients positive for human epidermal growth receptor 2 (n=354, 41.5%) received monoclonal antibodies on top of allocated therapy; 119 (12.9%) of all patients showed a cardiotoxic reaction during therapy (15 [1.8%] using a more strict definition). Presence of cardiotoxic reactions was irrespective of treatment allocation (P=0.31). Small but significant increases in NT-proBNP developed early in patients with a cardiotoxic reaction as compared with those without in whom NT-proBNP rose only towards the end of therapy (P=0.04). High-sensitivity cardiac troponin T rose early in both groups. Logistic regression showed that NT-proBNP (odds ratio [OR], 1.03; 95% CI, 1.008-1.055; P=0.01) and hemoglobin (OR, 1.31; 95% CI, 1.05-1.63; P=0.02) measured at 6 weeks after treatment initiation were significantly associated with cardiotoxic reactions. Conclusions NT-proBNP and hemoglobin are significantly associated with cardiotoxic reactions in patients with early-stage breast cancer undergoing dose-dense and dose-intensified chemotherapy, but high-sensitivity cardiac troponin T is not. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT02125344.
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Affiliation(s)
- Alexandra Maria Rüger
- Department of CardiologyCharité – Universitätsmedizin BerlinBerlin, Campus Virchow‐KlinikumBerlinGermany
| | - Andreas Schneeweiss
- National Center for Tumor DiseasesUniversity Hospital and German Cancer Research CenterHeidelbergGermany
| | - Sabine Seiler
- German Breast GroupNeu‐Isenburg and Center for Hematology and Oncology BethanienFrankfurtGermany
| | | | | | - Frederik Marmé
- Department of Gynecologic OncologyMedical Faculty MannheimHeidelberg UniversityUniversity Hospital MannheimMannheimGermany
| | | | - Bruno Sinn
- Charité Universitätsmedizin BerlinBerlinGermany
| | - Thomas Karn
- Goethe University Hospital FrankfurtFrankfurtGermany
| | | | - Volkmar Müller
- Department of GynecologyUniversity Medical Center Hamburg EppendorfHamburgGermany
| | | | | | | | - Valentina Nekljudova
- German Breast GroupNeu‐Isenburg and Center for Hematology and Oncology BethanienFrankfurtGermany
| | - Tania Garfias‐Macedo
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Gerd Hasenfuß
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Wilhelm Haverkamp
- Department of CardiologyCharité – Universitätsmedizin BerlinBerlin, Campus Virchow‐KlinikumBerlinGermany
| | - Sibylle Loibl
- German Breast GroupNeu‐Isenburg and Center for Hematology and Oncology BethanienFrankfurtGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
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Conti S, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, Macle L, Morillo CA, Haverkamp W, Weerasooriya R, Albenque JP, Nardi S, Menardi E, Novak P, Sanders P, Verma A. Effect of Postablation Monitoring Strategy on Long-Term Outcome for Catheter Ablation of Persistent Atrial Fibrillation: A Substudy of the STAR AF II Trial. Circ Arrhythm Electrophysiol 2020; 13:e008682. [PMID: 33034510 DOI: 10.1161/circep.120.008682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sergio Conti
- Southlake Regional Health Centre, Newmarket, Canada (S.C., A.V.)
- University of Tor Vergata, Rome, Italy (S.C.)
| | - Chen-Yang Jiang
- Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China (C.-y.J.)
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals, John Radcliffe Hospital, United Kingdom (T.R.B.)
| | - Jian Chen
- Haukeland University Hospital, University of Bergen, Norway (J.C.)
| | | | | | | | - Carlos A Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Canada (C.A.M.)
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany (W.H.)
| | - Rukshen Weerasooriya
- Department of Cardiology, Hollywood Private Hospital, Nedlands, Western Australia (R.W.)
- Department of Cardiology, University of Western Australia, Crawley (R.W.)
| | | | - Stefano Nardi
- Pineta Grande Hospital, Castel Volturno, Italy (S.N.)
| | | | - Paul Novak
- Royal Jubilee Hospital, Victoria, Canada (P.N.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Australia (P.S.)
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Canada (S.C., A.V.)
- Department of Surgery, University of Toronto, Canada (A.V.)
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Limmroth V, Ziemssen T, Kleiter I, Wagner B, Schmidt S, Lassek C, Baier-Ebert M, Wendt G, Dechend R, Haverkamp W. A Comprehensive Monitoring Study on Electrocardiographic Assessments and Cardiac Events After Fingolimod First Dose-Possible Predictors of Cardiac Outcomes. Front Neurol 2020; 11:818. [PMID: 32903376 PMCID: PMC7434833 DOI: 10.3389/fneur.2020.00818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background: First dose observation for cardiac effects is required for fingolimod. Previous results in patients with relapsing remitting multiple sclerosis (RRMS) suggest that transient bradycardia and conduction abnormalities during the observation phase are rare, benign and reversible. Prior analyses corroborate these findings. The present large scale dataset allows subgroup analyses for differences in the incidence of cardiac findings depending on patient characteristics. Methods: START was an open-label, multi-center study that enrolled 6,998 RRMS patients. Primary endpoints were incidence of bradycardia (heart rate < 45 bpm) and second-/third-degree atrioventricular (AV) block during treatment initiation. Subgroup analyses were performed according to age, gender, body mass index (BMI), baseline expanded disability status scale (EDSS), and concomitant medication to determine the impact of these variables on cardiac outcomes parameters. Results: 63 patients (0.9%) developed bradycardia (<45 bpm), 120 patients (1.7%) had a second-degree Mobitz I (Wenkebach) block and/or 2:1 AV block. One case of an asymptomatic third-degree AV block occurred. No Mobitz II AV block was observed. After 1 week, no second-/third-degree AV block was observed. The incidence of second- or third-degree AV blocks was significantly higher in older patients (≥50 years; p = 0.014 vs. patients 35–49 years). Second- or third-degree AV blocks were more frequent in females (87.5% of all patients with a second- or third-degree AV block; p < 0.001), while bradycardia occurred more often in males (58.7% of all bradycardia events; p < 0.001). Furthermore, patients with a BMI below 25 had a higher incidence of second- or third-degree AV block. Conclusions: In summary, transient bradycardia and AV conduction abnormalities after the first dose of fingolimod were rare and asymptomatic. When compared to females, male patients might have a higher risk for bradycardia during treatment initiation, presumably due to a lower resting heart rate. Furthermore, a low heart rate before treatment initiation, low body weight, or low BMI possibly increases the risk for bradycardia. Second- or third-degree AV blocks were more frequent in females, older patients and patients with a low BMI. Nevertheless, these cardiac events remained rare and benign, confirming the favorable cardiac safety profile of fingolimod upon treatment initiation in MS patients without cardiovascular comorbidities.
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Affiliation(s)
- Volker Limmroth
- Department of Neurology, Cologne General Hospitals, University of Cologne, Cologne, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, University Clinic Carl Gustav Carus Dresden, Dresden, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | | | - Stephan Schmidt
- Neurologische Gemeinschaftspraxis Schmidt, Neudecker, Viebahn und Kronenberger, Bonn, Germany
| | - Christoph Lassek
- Neurologische Gemeinschaftspraxis Kassel und Vellmar, Kassel, Germany
| | | | | | - Ralf Dechend
- Experimental and Clinical Research Center, Charité-Campus Buch and HELIOS Klinikum, Berlin, Germany
| | - Wilhelm Haverkamp
- Division for Metabolism and Cardiology, Department of Cardiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
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Brandt J, Warnke K, Jörgens S, Arolt V, Beer K, Domschke K, Haverkamp W, Kuhlmann SL, Müller-Nordhorn J, Rieckmann N, Schwarte K, Ströhle A, Tschorn M, Waltenberger J, Grosse L. Association of FKBP5 genotype with depressive symptoms in patients with coronary heart disease: a prospective study. J Neural Transm (Vienna) 2020; 127:1651-1662. [PMID: 32860562 PMCID: PMC7665971 DOI: 10.1007/s00702-020-02243-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
Depression and coronary heart disease (CHD) are prevalent and often co-occurring disorders. Both have been associated with a dysregulated stress system. As a central element of the stress system, the FKBP5 gene has been shown to be associated with depression. In a prospective design, this study aims to investigate the association of FKBP5 with depressive symptoms in CHD patients. N = 268 hospitalized CHD patients were included. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS-D) at four time points (baseline, and after 1 month, 6 months, and 12 months). The functional FKBP5 single-nucleotide polymorphism (SNP) rs1360780 was selected for genotyping. Linear regression models showed that a higher number of FKBP5 C alleles was associated with more depressive symptoms in CHD patients both at baseline (p = 0.015) and at 12-months follow-up (p = 0.025) after adjustment for confounders. Further analyses revealed that this effect was driven by an interaction of FKBP5 genotype with patients’ prior CHD course. Specifically, only in patients with a prior myocardial infarction or coronary revascularization, more depressive symptoms were associated with a higher number of C alleles (baseline: p = 0.046; 1-month: p = 0.026; 6-months: p = 0.028). Moreover, a higher number of C alleles was significantly related to a greater risk for dyslipidemia (p = .016). Our results point to a relevance of FKBP5 in the association of the two stress-related diseases depression and CHD.
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Affiliation(s)
- Julia Brandt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Geb. A9, 48149, Münster, Germany.
| | - Katharina Warnke
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Geb. A9, 48149, Münster, Germany
| | - Silke Jörgens
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Geb. A9, 48149, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Geb. A9, 48149, Münster, Germany
| | - Katja Beer
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wilhelm Haverkamp
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Internal Medicine and Cardiology, Berlin, Germany
| | - Stella L Kuhlmann
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Division of Emergency and Acute Medicine (CVK, CCM), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Public Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Public Health, Berlin, Germany
- Bavarian Food and Health Safety Authority, Oberschleißheim, Germany
| | - Nina Rieckmann
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Public Health, Berlin, Germany
| | - Kathrin Schwarte
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Geb. A9, 48149, Münster, Germany
| | - Andreas Ströhle
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Mira Tschorn
- Charité-Universitätsmedizin Berlin, Corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | | | - Laura Grosse
- Department of Psychiatry and Psychotherapy, University Hospital Münster, Albert-Schweitzer-Campus 1, Geb. A9, 48149, Münster, Germany
- Intercultural Business Psychology, Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
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Kuhlmann SL, Arolt V, Haverkamp W, Martus P, Ströhle A, Waltenberger J, Rieckmann N, Müller-Nordhorn J. Prevalence, 12-Month Prognosis, and Clinical Management Need of Depression in Coronary Heart Disease Patients: A Prospective Cohort Study. Psychother Psychosom 2020; 88:300-311. [PMID: 31450228 DOI: 10.1159/000501502] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Screening for depression in patients with coronary heart disease (CHD) remains controversial. There is limited data on the actual depression management need in routine care. The aim of this study was to examine the prevalence, treatment rates, prognosis, and management need of clinical and subclinical depression in CHD patients according to the American Heart Association recommendations and the National Institute for Health and Care Excellence (NICE) guideline "Depression in Adults with a Chronic Physical Health Problem". METHODS Patients were recruited at 2 German university clinics between 2012 and 2014. Depressive disorders were assessed according to the DSM-IV and depressive symptom severity at baseline and during follow-up was evaluated with the Patient Health Questionnaire (PHQ-9). Depression management need was determined by the severity and longitudinal course of depression symptoms. RESULTS Of 1,024 patients (19% women), 12% had clinical depression (depressive disorder) and 45% had subclinical depression (PHQ-9 score ≥5) at baseline. Among those with clinical depression, 46% were in treatment at least once during 12 months; 26% were continuously in treatment during follow-up. Depressive disorder and depressive symptoms were significant risk factor-adjusted predictors of the 12-months mortality (adjusted HR = 3.19; 95% CI 1.32-7.69, and adjusted HR = 1.09; 95% CI 1.02-1.16, respectively). Depressive symptoms persisted in 85% of the clinically depressed and in 47% of the subclinically depressed patients. According to current recommendations, 29% of all CHD patients would require depression management within 1 year. CONCLUSIONS There is a need for enhanced recognition, referral, and continuous and improved clinical management of depression in CHD patients.
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Affiliation(s)
- Stella L Kuhlmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany, .,Division of Emergency and Acute Medicine (CVK, CCM), Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany,
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Wilhelm Haverkamp
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Peter Martus
- Department of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
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Weitz JI, Haas S, Ageno W, Goldhaber SZ, Turpie AGG, Goto S, Angchaisuksiri P, Nielsen JD, Kayani G, Farjat AE, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK, Loualidi A, Colak A, Bezuidenhout A, Abdool-Carrim A, Azeddine A, Beyers A, Dees A, Mohamed A, Aksoy A, Abiko A, Watanabe A, Krichell A, Fernandez AA, Tosetto A, Khotuntsov A, Oropallo A, Slocombe A, Kelly A, Clark A, Gad A, Arouni A, Schmidt A, Berni A, Kleiban AJ, Machowski A, Kazakov A, Galvez A, Lockman A, Falanga A, Chauhan A, Riera-Mestre A, Mazzone A, D’Angelo A, Herdy A, Kato A, Salem AAEEM, Husin A, Erdelyi B, Jacobson B, Amann-Vesti B, Battaloglu B, Wilson B, Cosmi B, Francois BJ, Toufek B, Hunt B, Natha B, Mustafa B, Kho BCS, Carine B, Zidel B, Dominique B, Christophe B, Trimarco B, Luo C, Cuneo CA, Diaz CJS, Schwencke C, Cader C, Yavuz C, Zaidman CJ, Lunn C, Wu CC, Toh CH, Chiang CE, Elisa C, Hsia CH, Huang CL, Kwok CHK, Wu CC, Huang CH, Ward C, Opitz C, Jeanneret-Gris C, Ha CY, Huang CY, Bidi CL, Smith C, Brauer C, Lodigiani C, Francis C, Wu C, Staub D, Theodoro D, Poli D, Acevedo DR, Adler D, Jimenez D, Keeling D, Scott D, Imberti D, Creagh D, Helene DC, Hagemann D, Le Roux D, Skowasch D, Belenky D, Dorokhov D, Petrov D, Zateyshchikov D, Prisco D, Møller D, Kucera D, Esheiba EM, Panchenko E, Dominique E, Dogan E, Kubat E, Diaz ED, Tse EWC, Yeo E, Hashas E, Grochenig E, Tiraferri E, Blessing E, Michèle EO, Usandizaga E, Porreca E, Ferroni F, Nicolas F, Ayala-Paredes F, Koura F, Henry F, Cosmi F, Erdkamp F, Kamalov G, Dalmau GB, Damien G, Klein G, Shah G, Hollanders G, Merli G, Plassmann G, Platt G, Poirier G, Sokurenko G, Haddad G, Ali G, Agnelli G, Gan GG, Kaye-Eddie G, Le Gal G, Allen G, Esperón GAL, Jean-Paul G, Gerofke H, Elali H, Burianova H, Ohler HJ, Wang H, Darius H, Gogia HS, Striekwold H, Gibbs H, Hasanoglu H, Turker H, Franow H, Bounameaux H, De Raedt H, Schroe H, ElDin HS, Zidan H, Nakamura H, Kim HY, Lawall H, Zhu H, Tian H, Yhim HY, Cate HT, Hwang HG, Shim H, Kim I, Libov I, Sonkin I, Suchkov I, Song IC, Kiris I, Staroverov I, Looi I, De La Azuela Tenorio IM, Savas I, Gordeev I, Podpera I, Lee JH, Sathar J, Welker J, Beyer-Westendorf J, Kvasnicka J, Vanwelden J, Kim J, Svobodova J, Gujral J, Marino J, Galvar JT, Kassis J, Kuo JY, Shih JY, Kwon J, Joh JH, Park JH, Kim JS, Yang J, Krupicka J, Lastuvka J, Pumprla J, Vesely J, Souto JC, Correa JA, Duchateau J, Fletcher JP, del Toro J, del Toro J, Paez JGC, Nielsen J, Filho JDA, Saraiva J, Peromingo JAD, Lara JG, Fedele JL, Surinach JM, Chacko J, Muntaner JA, Benitez JCÁ, Abril JMH, Humphrey J, Bono J, Kanda J, Boondumrongsagoon J, Yiu KH, Chansung K, Boomars K, Burbury K, Kondo K, Karaarslan K, Takeuchi K, Kroeger K, Zrazhevskiy K, Svatopluk K, Shyu KG, Vandenbosch K, Chang KC, Chiu KM, Jean-Manuel K, Wern KJ, Ueng KC, Norasetthada L, Binet L, Chew LP, Zhang L, Cristina LM, Tick L, Schiavi LB, Wong LLL, Borges L, Botha L, Capiau L, Timmermans L, López LE, Ria L, Blasco LMH, Guzman LA, Cervera LF, Isabelle M, Bosch MM, de los Rios Ibarra M, Fernandez MN, Carrier M, Barrionuevo MR, Gamba MAA, Cattaneo M, Moia M, Bowers M, Chetanachan M, Berli MA, Fixley M, Faghih M, Stuecker M, Schul M, Banyai M, Koretzky M, Myriam M, Gaffney ME, Hirano M, Kanemoto M, Nakamura M, Tahar M, Emmanuel M, Kovacs M, Leahy M, Levy M, Munch M, Olsen M, De Pauw M, Gustin M, Van Betsbrugge M, Boyarkin M, Homza M, Koto M, Abdool-Gaffar M, Nagib MAF, Dessoki ME, Khan M, Mohamed M, Kim MH, Lee MH, Soliman M, Ahmed MS, Bary MSAE, Moustafa MA, Hameed M, Kanko M, Majumder M, Zubareva N, Mumoli N, Abdullah NAN, Makruasi N, Paruk N, Kanitsap N, Duda N, Nordin N, Nyvad O, Barbarash O, Gurbuz O, Vilamajo OG, Flores ON, Gur O, Oto O, Marchena PJ, Angchaisuksiri P, Carroll P, Lang P, MacCallum P, von Bilderling PB, Blombery P, Verhamme P, Jansky P, Bernadette P, De Vleeschauwer P, Hainaut P, Ferrini PM, Iamsai P, Christian P, Viboonjuntra P, Rojnuckarin P, Ho P, Mutirangura P, Wells R, Martinez R, Miranda RT, Kroening R, Ratsela R, Reyes RL, de Leon RFD, Wong RSM, Alikhan R, Jerwan-Keim R, Otero R, Murena-Schmidt R, Canevascini R, Ferkl R, White R, Van Herreweghe R, Santoro R, Klamroth R, Mendes R, Prosecky R, Cappelli R, Spacek R, Singh R, Griffin S, Na SH, Chunilal S, Middeldorp S, Nakazawa S, Schellong S, Toh SG, Christophe S, Isbir S, Raymundo S, Ting SK, Motte S, Aktogu SO, Donders S, Cha SI, Nam SH, Marie-Antoinette SP, Maasdorp S, Sun S, Wang S, Essameldin SM, Sholkamy SM, Kuki S, Goto S, Yoshida S, Matsuoka S, McRae S, Watt S, Patanasing S, Jean-Léopold SN, Wongkhantee S, Bang SM, Testa S, Zemek S, Behrens S, Dominique S, Mellor S, Singh SSG, Datta S, Chayangsu S, Solymoss S, Everington T, Abdel-Azim TAA, Suwanban T, Adademir T, Hart T, Béatrice T, Luvhengo T, Horacek T, Zeller T, Boussy T, Reynolds T, Biss T, Chao TH, Casabella TS, Onodera T, Numbenjapon T, Gerdes V, Cech V, Krasavin V, Tolstikhin V, Bax WA, Malek WFA, Ho WK, Ageno W, Pharr W, Jiang W, Lin WH, Zhang W, Tseng WK, Lai WT, De Backer W, Haverkamp W, Yoshida W, Korte W, Choi W, Kim YK, Tanabe Y, Ohnuma Y, Mun YC, Balthazar Y, Park Y, Shibata Y, Burov Y, Subbotin Y, Coufal Z, Yang Z, Jing Z, Jing Z, Yang Z. Cancer associated thrombosis in everyday practice: perspectives from GARFIELD-VTE. J Thromb Thrombolysis 2020; 50:267-277. [DOI: 10.1007/s11239-020-02180-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Bannehr M, Löhr L, Gelep J, Haverkamp W, Schunck WH, Gollasch M, Wutzler A. Linoleic Acid Metabolite DiHOME Decreases Post-ischemic Cardiac Recovery in Murine Hearts. Cardiovasc Toxicol 2020; 19:365-371. [PMID: 30725262 DOI: 10.1007/s12012-019-09508-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiac ischemia/reperfusion injury is associated with the formation and action of lipid mediators derived from polyunsaturated fatty acids. Among them, linoleic acid (LA) is metabolized to epoxyoctadecanoic acids (EpOMEs) by cytochrome P450 (CYP) epoxygenases and further to dihydroxyoctadecanoic acids (DiHOMEs) by soluble epoxide hydrolase (sEH). We hypothesized that EpOMEs and/or DiHOMEs may affect cardiac post-ischemic recovery and addressed this question using isolated murine hearts in a Langendorff system. Hearts from C57Bl6 mice were exposed to 12,13-EpOME, 12,13-DiHOME, or vehicle (phosphate buffered sodium; PBS). Effects on basal cardiac function and functional recovery during reperfusion following 20 min of ischemia were investigated. Electrocardiogram (ECG), left ventricular (LV) pressure and coronary flow (CF) were continuously measured. Ischemia reperfusion experiments were repeated after administration of the sEH-inhibitor 12-(3-adamantan-1-yl-ureido)dodecanoic acid (AUDA). At a concentration of 100 nM, both EpOME and DiHOME decreased post-ischemic functional recovery in murine hearts. There was no effect on basal cardiac parameters. The detrimental effects seen with EpOME, but not DiHOME, were averted by sEH inhibition (AUDA). Our results indicate that LA-derived mediators EpOME/DiHOME may play an important role in cardiac ischemic events. Inhibition of sEH could provide a novel treatment option to prevent detrimental DiHOME effects in acute cardiac ischemia.
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Affiliation(s)
- Marwin Bannehr
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Lena Löhr
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Julia Gelep
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Maik Gollasch
- Experimental and Clinical Research Center, 16341, Berlin, Germany
- Department of Nephrology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alexander Wutzler
- Experimental and Clinical Research Center, 16341, Berlin, Germany
- Department of Electrophysiology and Cardiac Rhythm Management, St. Joseph Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
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32
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Lacour P, Dang PL, Morris DA, Parwani AS, Doehner W, Schuessler F, Hohendanner F, Heinzel FR, Stroux A, Tschoepe C, Haverkamp W, Boldt LH, Pieske B, Blaschke F. The effect of iron deficiency on cardiac resynchronization therapy: results from the RIDE-CRT Study. ESC Heart Fail 2020; 7:1072-1084. [PMID: 32189474 PMCID: PMC7261541 DOI: 10.1002/ehf2.12675] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/09/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) improves functional status, induces reverse left ventricular remodelling, and reduces hospitalization and mortality in patients with symptomatic heart failure, left ventricular systolic dysfunction, and QRS prolongation. However, the impact of iron deficiency on CRT response remains largely unclear. The purpose of the study was to assess the effect of functional and absolute iron deficiency on reverse cardiac remodelling, clinical response, and outcome after CRT implantation. Methods and results The relation of iron deficiency and cardiac resynchronization therapy response (RIDE‐CRT) study is a prospective observational study. We enrolled 77 consecutive CRT recipients (mean age 71.3 ± 10.2 years) with short‐term follow‐up of 3.3 ± 1.9 months and long‐term follow‐up of 13.0 ± 3.2 months. Primary endpoints were reverse cardiac remodelling on echocardiography and clinical CRT response, assessed by change in New York Heart Association classification. Echocardiographic CRT response was defined as relative improvement of left ventricular ejection fraction ≥ 20% or left ventricular global longitudinal strain ≥ 20%. Secondary endpoints were hospitalization for heart failure and all‐cause mortality (mean follow‐up of 29.0 ± 8.4 months). At multivariate analysis, iron deficiency was identified as independent predictor of echocardiographic (hazard ratio 4.97; 95% confidence interval 1.15–21.51; P = 0.03) and clinical non‐response to CRT (hazard ratio 4.79; 95% confidence interval 1.30–17.72, P = 0.02). We found a significant linear‐by‐linear association between CRT response and type of iron deficiency (P = 0.004 for left ventricular ejection fraction improvement, P = 0.02 for left ventricular global longitudinal strain improvement, and P = 0.003 for New York Heart Association response). Iron deficiency was also significantly associated with an increase in all‐cause mortality (P = 0.045) but not with heart failure hospitalization. Conclusions Iron deficiency is a negative predictor of effective CRT therapy as assessed by reverse cardiac remodelling and clinical response. Assessment of iron substitution might be a relevant treatment target to increase CRT response and outcome in chronic heart failure patients.
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Affiliation(s)
- Philipp Lacour
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Phi Long Dang
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Daniel Armando Morris
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Abdul Shokor Parwani
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Wolfram Doehner
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,BCRT-Center for Regenerative Therapies.,Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Franziska Schuessler
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Felix Hohendanner
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Andrea Stroux
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12203, Germany.,Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Carsten Tschoepe
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Florian Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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33
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Hohls JK, Beer K, Arolt V, Haverkamp W, Kuhlmann SL, Martus P, Waltenberger J, Rieckmann N, Müller-Nordhorn J, Ströhle A. Association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease. J Psychosom Res 2020; 131:109958. [PMID: 32120145 DOI: 10.1016/j.jpsychores.2020.109958] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyze the association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease (CHD). METHODS N = 1007 patients with CHD were recruited in hospital and followed for one year in a two-site cohort study. Heart focused anxiety (Cardiac Anxiety Questionnaire [CAQ] with the three subscales fear, attention, and avoidance), depressive symptoms (depression module from the Patient Health Questionnaire [PHQ-9]), health behaviors and healthcare utilization (smoking status, alcohol consumption, physical activity, outpatient physician/psychotherapist visits) were assessed six months after the initial hospitalization. Multiple regression models were used for statistical analysis. RESULTS About one third of the sample exhibited clinically significant CAQ scores. Higher CAQ-avoidance scores were associated with current smoking (OR = 1.62; 95%CI: 1.33-1.98), reduced alcohol intake (OR = 0.83; 95%CI: 0.71-0.98), non-participation in a coronary exercise group (OR = 1.76; 95%CI: 1.42-2.17), less regular physical activity (OR = 2.69; 95%CI: 2.32-3.12), and more frequent contact to general practitioners (GPs; b = 0.07, SE: 0.03). CAQ-attention was associated with non-smoking (OR = 0.51; 95%CI: 0.37-0.70), exercise group participation (OR = 0.69; 95%CI: 0.51-0.94), more frequent regular physical activity (OR = 0.55; 95%CI: 0.44-0.68), and more frequent contact to specialists for internal medicine (b = 0.09, SE: 0.04). CAQ-fear was not associated with any of the health behavior or healthcare use measures. Depressive symptoms were associated with reduced regular physical activity (OR = 1.05; 95%CI: 1.02-1.08) and increased contact to mental care specialists (b = 0.03, SE: 0.01) and GPs (b = 0.02, SE: 0.01). CONCLUSIONS Heart-focused anxiety and depressive symptoms may impede secondary prevention in patients with CHD and increase outpatient healthcare utilization.
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Affiliation(s)
- Johanna Katharina Hohls
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Katja Beer
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Münster, Münster, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stella Linnea Kuhlmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Division of Emergency and Acute Medicine (CVK, CCM), Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, Universität Tübingen, Tübingen, Germany
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany; Department of Internal Medicine I, SRH Central Hospital Suhl, Suhl, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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34
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Hornung J, Kuhlmann SL, Radzimanowski M, Jörgens S, Haverkamp W, Martus P, Ströhle A, Waltenberger J, Arolt V, Müller-Nordhorn J, Rieckmann N. Depressive symptoms and health care within 30 days after discharge from a cardiac hospital unit: Response letter to the editor. Gen Hosp Psychiatry 2020; 62:100-101. [PMID: 30712926 DOI: 10.1016/j.genhosppsych.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Jakob Hornung
- Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Stella Linnea Kuhlmann
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Division of Emergency and Acute Medicine (CVK, CCM), Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
| | - Maria Radzimanowski
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
| | - Silke Jörgens
- Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Wilhelm Haverkamp
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Peter Martus
- Institute for Epidemiology and Applied Biometry, University of Tübingen, Silcherstraße 5, 72076 Tübingen, Germany.
| | - Andreas Ströhle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charitéplatz 1, 10117 Berlin, Germany.
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Jacqueline Müller-Nordhorn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
| | - Nina Rieckmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
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35
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Anker MS, Hadzibegovic S, Lena A, Haverkamp W. The difference in referencing in Web of Science, Scopus, and Google Scholar. ESC Heart Fail 2019; 6:1291-1312. [PMID: 31886636 PMCID: PMC6989289 DOI: 10.1002/ehf2.12583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS How often a medical article is cited is important for many people because it is used to calculate different variables such as the h-index and the journal impact factor. The aim of this analysis was to assess how the citation count varies between Web of Science (WoS), Scopus, and Google Scholar in the current literature. METHODS We included the top 50 cited articles of four journals ESC Heart Failure; Journal of cachexia, sarcopenia and muscle; European Journal of Preventive Cardiology; and European Journal of Heart Failure in our analysis that were published between 1 January 2016 and 10 October 2019. We recorded the number of citations of these articles according to WoS, Scopus, and Google Scholar on 10 October 2019. RESULTS The top 50 articles in ESC Heart Failure were on average cited 12 (WoS), 13 (Scopus), and 17 times (Google Scholar); in Journal of cachexia, sarcopenia and muscle 37 (WoS), 43 (Scopus), and 60 times (Google Scholar); in European Journal of Preventive Cardiology 41 (WoS), 56 (Scopus), and 67 times (Google Scholar); and in European Journal of Heart Failure 76 (WoS), 108 (Scopus), and 230 times (Google Scholar). On average, the top 50 articles in all four journals were cited 41 (WoS), 52 (Scopus, 26% higher citations count than WoS, range 8-42% in the different journals), and 93 times (Google Scholar, 116% higher citation count than WoS, range 42-203%). CONCLUSION Scopus and Google Scholar on average have a higher citation count than WoS, whereas the difference is much larger between Google Scholar and WoS.
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Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin (CBF), Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sara Hadzibegovic
- Division of Cardiology and Metabolism, Department of Cardiology, Charité Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin (CBF), Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Alessia Lena
- Division of Cardiology and Metabolism, Department of Cardiology, Charité Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin (CBF), Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Wilhelm Haverkamp
- Division of Cardiology and Metabolism, Department of Cardiology, Charité Campus Virchow Klinikum (CVK), Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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36
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Saussele S, Haverkamp W, Lang F, Koschmieder S, Kiani A, Jentsch-Ullrich K, Stegelmann F, Pfeifer H, La Rosée P, Goekbuget N, Rieger C, Waller CF, Franke GN, le Coutre P, Kirchmair R, Junghanss C. Ponatinib in the Treatment of Chronic Myeloid Leukemia and Philadelphia Chromosome-Positive Acute Leukemia: Recommendations of a German Expert Consensus Panel with Focus on Cardiovascular Management. Acta Haematol 2019; 143:217-231. [PMID: 31590170 DOI: 10.1159/000501927] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 12/14/2022]
Abstract
Treatment of chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute leukemia (Ph+ ALL) has been revolutionized with the advent of tyrosine kinase inhibitors (TKIs). Most patients with CML achieve long-term survival similar to individuals without CML due to treatment with TKIs not only in frontline but also in further lines of therapy. The third-generation TKI ponatinib has demonstrated efficacy in patients with refractory CML and Ph+ ALL. Ponatinib is currently the most potent TKI in this setting demonstrating activity against T315I mutant clones. However, ponatinib's safety data revealed a dose-dependent, increased risk of serious cardiovascular (CV) events. Guidance is needed to evaluate the benefit-risk profile of TKIs, such as ponatinib, and safety measures to prevent treatment-associated CV events. An expert panel of German hematologists and cardiologists summarize current evidence regarding ponatinib's efficacy and CV safety profile. We propose CV management strategies for patients who are candidates for ponatinib.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Cardiovascular Diseases/chemically induced
- Cardiovascular Diseases/physiopathology
- Cardiovascular Diseases/prevention & control
- Clinical Trials as Topic
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm
- Female
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Hyperglycemia/complications
- Hyperglycemia/drug therapy
- Hyperlipidemias/complications
- Hyperlipidemias/drug therapy
- Hypertension/complications
- Hypertension/drug therapy
- Imidazoles/administration & dosage
- Imidazoles/adverse effects
- Imidazoles/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Philadelphia Chromosome
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/enzymology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Progression-Free Survival
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Pyridazines/administration & dosage
- Pyridazines/adverse effects
- Pyridazines/therapeutic use
- Risk Assessment
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Affiliation(s)
- Susanne Saussele
- Department of Haematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany,
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Fabian Lang
- Department of Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Steffen Koschmieder
- Department of Medicine, Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Alexander Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | | | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Heike Pfeifer
- Department of Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Paul La Rosée
- Department of Medicine II, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Nicola Goekbuget
- Department of Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Christina Rieger
- Hemato-Oncology Germering, Germering, Germany and Ludwig Maximilians University Munich, Munich, Germany
| | - Cornelius F Waller
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Philipp le Coutre
- Department of Medicine, Hematology and Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rudolf Kirchmair
- Department of Internal Medicine III: Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Junghanss
- Department of Medicine, Clinic III: Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
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37
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Herm J, Haeusler KG, Kunze C, Krüll M, Brechtel L, Lock J, Heuschmann PU, Haverkamp W, Heekeren H, Liman T, Endres M, Fiebach JB, Jungehulsing GJ. MRI Brain Changes After Marathon Running: Results of the Berlin Beat of Running Study. Int J Sports Med 2019; 40:856-862. [PMID: 31505701 DOI: 10.1055/a-0958-9548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Several studies report neurological complications such as brain injury induced by ischemia or edema following exhaustive endurance sport. We aimed to detect the frequency of acute brain lesions after a marathon race. In the prospective observational Berlin Beat of Running study, 110 experienced endurance athletes underwent 3-Tesla brain MRI exams 2-3 days prior and within 2 days after a marathon run. MRI results were compared to an age- and sex-matched control group of 68 non-athletes, including the "Age-Related White Matter Changes" (ARWMC) scale to assess white matter lesions (WML) in the brain. 108 athletes (median age 48 years, 24% female, 8% with hypertension; 0% with diabetes) completed the race. No athlete reported neurological deficits, but a single acute ischemic lesion was detected in diffusion-weighted MRI after the race in one athlete. No other acute brain lesions compared to prior MRI were found. An ARWMC score ≥4 was found in 15% of athletes and 12% of non-athletic controls (p=0.7). Chronic ischemic lesions were not found in athletes but in four controls (6%) (p=0.02). In conclusion, acute ischemic brain lesions may be found in endurance runners. Every seventh endurance athlete and every ninth control showed evidence for substantial white matter lesions.
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Affiliation(s)
- Juliane Herm
- Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Claudia Kunze
- Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Krüll
- SMS Medical Institute Berlin GmbH, Berlin, Germany.,SCC EVENTS GmbH, Berlin, Germany
| | - Lars Brechtel
- Carl Remigius Medical School, Physician Assistance, Hamburg, Germany.,Berlin Academy of Sports Medicine, Sports Medicine, Berlin, Germany
| | - Jürgen Lock
- SMS Medical Institute Berlin GmbH, Berlin, Germany.,SCC EVENTS GmbH, Berlin, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Hauke Heekeren
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Thomas Liman
- Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité Universitätsmedizin Berlin, German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,Charité Universitätsmedizin Berlin, Excellence Cluster NeuroCure, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
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Kuhlmann SL, Arolt V, Haverkamp W, Ströhle A, Waltenberger J, Müller-Nordhorn J, Rieckmann N. [Attitudes towards depression and treatment options in patients with coronary heart disease]. Nervenarzt 2019; 90:938-940. [PMID: 31098651 DOI: 10.1007/s00115-019-0736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stella L Kuhlmann
- Institut für Public Health, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Seestraße 73, 13347, Berlin, Deutschland.
- Arbeitsbereich Notfallmedizin (CVK, CCM), Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland.
| | - Volker Arolt
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Münster, Deutschland
| | - Wilhelm Haverkamp
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Andreas Ströhle
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - Johannes Waltenberger
- Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Jacqueline Müller-Nordhorn
- Institut für Public Health, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Seestraße 73, 13347, Berlin, Deutschland
| | - Nina Rieckmann
- Institut für Public Health, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Seestraße 73, 13347, Berlin, Deutschland
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Lacour P, Buschmann C, Storm C, Nee J, Parwani AS, Huemer M, Attanasio P, Boldt LH, Rauch G, Kucher A, Pieske B, Haverkamp W, Blaschke F. Cardiac Implantable Electronic Device Interrogation at Forensic Autopsy: An Underestimated Resource? Circulation 2019; 137:2730-2740. [PMID: 29915100 DOI: 10.1161/circulationaha.117.032367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postmortem interrogations of cardiac implantable electronic devices (CIEDs), recommended at autopsy in suspected cases of sudden cardiac death, are rarely performed, and data on systematic postmortem CIED analysis in the forensic pathology are missing. The aim of the study was to determine whether nonselective postmortem CIED interrogations and data analysis are useful to the forensic pathologist to determine the cause, mechanism, and time of death and to detect potential CIED-related safety issues. METHODS From February 2012 to April 2017, all autopsy subjects in the department of forensic medicine at the University Hospital Charité who had a CIED underwent device removal and interrogation. Over the study period, 5368 autopsies were performed. One hundred fifty subjects had in total 151 CIEDs, including 109 pacemakers, 35 defibrillators, and 7 implantable loop recorders. RESULTS In 40 cases (26.7%) time of death and in 51 cases (34.0%) cause of death could not be determined by forensic autopsy. Of these, CIED interrogation facilitated the determination of time of death in 70.0% of the cases and clarified the cause of death in 60.8%. Device concerns were identified in 9 cases (6.0%), including 3 hardware, 4 programming, and 2 algorithm issues. One CIED was submitted to the manufacturer for a detailed technical analysis. CONCLUSIONS Our data demonstrate the necessity of systematic postmortem CIED interrogation in forensic medicine to determine the cause and timing of death more accurately. In addition, CIED analysis is an important tool to detect potential CIED-related safety issues.
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Affiliation(s)
- Philipp Lacour
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
| | - Claas Buschmann
- Campus Virchow-Klinikum, Germany. Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Legal Medicine and Forensic Sciences, Campus Mitte, Germany (C.B.)
| | - Christian Storm
- Department of Nephrology and Intensive Care Medicine (C.S., J.N.)
| | - Jens Nee
- Department of Nephrology and Intensive Care Medicine (C.S., J.N.)
| | - Abdul Shokor Parwani
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
| | - Martin Huemer
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
| | - Philipp Attanasio
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
| | - Leif-Hendrik Boldt
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
| | - Geraldine Rauch
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Germany (G.R.)
| | | | - Burkert Pieske
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
| | - Wilhelm Haverkamp
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
| | - Florian Blaschke
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology (P.L., A.S.P., M.H., P.A., L.-H.B., B.P., W.H., F.B.)
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40
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Ziagaki A, Blaschke D, Haverkamp W, Plöckinger U. Long-term growth hormone (GH) replacement of adult GH deficiency (GHD) benefits the heart. Eur J Endocrinol 2019; 181:79-91. [PMID: 31100717 DOI: 10.1530/eje-19-0132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/16/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Growth hormone (GH) deficiency is related to increased cardiovascular mortality. We studied clinical status, concentration of amino-terminal-pro B-type natriuretic-peptide (NT-proBNP) and echocardiographic parameters during long-term GH replacement (GH-R). METHODS Fifty-one patients (29 females), 45.9 ± 11.3 years (mean ± s.d.), median follow-up 36.2 months, echocardiography and laboratory determinations initially and at 12-months intervals. RESULTS At the last follow-up (last observation carried forward) (LFU (LOCF)) insulin-like growth-factor-1 standard deviation score (IGF-1 SDS) was ±1 in 92% of the patients. The median NT-proBNP declined significantly and stabilized (-40.5%) at LFU (LOCF) due to patients with a basal NT-proBNP >125 ng/L (indicative of heart failure). The basal NT-proBNP and the final IGF-1 SDS were significant predictors of the NT-proBNP at LFU (LOCF). Initially left ventricular enddiastolic diameter (LVEDD), left ventricular posterior wall diameter (LVPWD) and ejection fraction (EF) were normal, while interventricular septum diameter (IVSD) and left ventricular mass index (LVMi) were slightly increased. LVPWD and IVSD had significantly declined by year three. The LVMi was moderately to severely abnormal in 37.3 and 52.0% of patients initially and at LFU (LOCF). At LFU (LOCF) LVMi and IGF-1 were significantly correlated in the 14 male patients of this subgroup. CONCLUSION Long-term GH-R of GHD positively affected ISVD and LVPWD. In a subgroup of patients with severe GHD, LVMi increased concomitantly to the decline in NT-proBNP and this was positively correlated to the final IGF-1 concentration. Whether this observation indicates a positive development in a structurally altered heart muscle (reversal of adverse remodelling) or poses a future risk for heart failure needs further follow-up.
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Affiliation(s)
- A Ziagaki
- Interdisciplinary Centre of Metabolism, Endocrinology, Diabetes and Metabolism
| | - D Blaschke
- Clinic of Cardiology, Charité - University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - W Haverkamp
- Clinic of Cardiology, Charité - University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - U Plöckinger
- Interdisciplinary Centre of Metabolism, Endocrinology, Diabetes and Metabolism
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Morris DA, Takeuchi M, Nakatani S, Otsuji Y, Belyavskiy E, Aravind Kumar R, Frydas A, Kropf M, Kraft R, Marquez E, Osmanoglou E, Krisper M, Köhncke C, Boldt LH, Haverkamp W, Tschöpe C, Edelmann F, Pieske B, Pieske-Kraigher E. Lower limit of normality and clinical relevance of left ventricular early diastolic strain rate for the detection of left ventricular diastolic dysfunction. Eur Heart J Cardiovasc Imaging 2019; 19:905-915. [PMID: 28977386 DOI: 10.1093/ehjci/jex185] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/22/2017] [Indexed: 12/25/2022] Open
Abstract
Aims The aim of the present study was to determine the lower limit of normality and the clinical relevance of left ventricular (LV) early diastolic strain rate (LVSRe) for the detection of LV diastolic dysfunction (LVDD). Methods and results Using 2D speckle-tracking echocardiography, we analysed 377 healthy subjects and 475 patients with risk for LVDD with preserved LV ejection fraction (LVEF). The normal range of LVSRe analysing the healthy subjects was 1.56 ± 0.28 s-1, with a lower limit of normality at 1.00 s-1. Using this cut-off, LVSRe was able to detect high rates of LV diastolic alterations (rate 71.1%), which was significantly better than using indirect diastolic parameters such as left atrial volume index (LAVI) and tricuspid regurgitation velocity (TR) (rates 22.9% and 9.1%) and similar to annular mitral parameters such as lateral and septal e' velocity (rates 70.9% and 72.4%). In line, adding LVSRe to the current evaluation of LVDD increased significantly the rate of detection of LVDD (absolute rate of increase 18.9%; rate of detection of LVDD: from 14.3% to 33.2%, P < 0.01). Regarding the clinical relevance of LVSRe, patients with abnormal LVSRe (i.e. <1.00 s-1) had significantly worse New York Heart Association functional class and symptomatic status than those with normal LVSRe. In addition, in a retrospective post hoc analysis, we found that an abnormal LVSRe had a significant association with the risk of heart failure hospitalization at 2 years (odds ratio 5.0, 95% confidence interval 1.3-18.4), which was better than using conventional diastolic parameters such as septal and lateral e' velocity, LAVI and TR velocity. Conclusion The findings from this multicentre study provide important data regarding the normal range of LVSRe and highlight the potential clinical relevance of using this new diastolic parameter in the detection of LVDD in patients with preserved LVEF.
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Affiliation(s)
- Daniel A Morris
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Masaaki Takeuchi
- Department of Internal Medicine and Cardiology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku Kitakyushu-shi, Fukuoka, 807-0804, Japan
| | - Satoshi Nakatani
- Department of Internal Medicine and Cardiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Yutaka Otsuji
- Department of Internal Medicine and Cardiology, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku Kitakyushu-shi, Fukuoka, 807-0804, Japan
| | - Evgeny Belyavskiy
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Radhakrishnan Aravind Kumar
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Athanasios Frydas
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Martin Kropf
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Robin Kraft
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Esteban Marquez
- Department of Radiology, Private Clinic of Radiology (Q-Diagnostica-Scanner Murcia), C/ Abenarabi, n° 3 Bajo - 30007 Murcia, Spain
| | - Engin Osmanoglou
- Department of Internal Medicine and Cardiology, Meoclinic, Quartier 206 - Friedrichstraße 7110117 Berlin, Germany
| | - Maximilian Krisper
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Clemens Köhncke
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Leif-Hendrik Boldt
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Wilhelm Haverkamp
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Carsten Tschöpe
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Oudenarder Straße 16, Berlin, Germany
| | - Frank Edelmann
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Oudenarder Straße 16, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Burkert Pieske
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Oudenarder Straße 16, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, Augustenburgerplatz 1, 13353 Berlin, Germany
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Anker MS, Holcomb R, Muscaritoli M, von Haehling S, Haverkamp W, Jatoi A, Morley JE, Strasser F, Landmesser U, Coats AJS, Anker SD. Orphan disease status of cancer cachexia in the USA and in the European Union: a systematic review. J Cachexia Sarcopenia Muscle 2019; 10:22-34. [PMID: 30920776 PMCID: PMC6438416 DOI: 10.1002/jcsm.12402] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [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: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cachexia has significant impact on the patients' quality of life and prognosis. It is frequently observed in patients with cancer, especially in advanced stages, but prevalence data for the overall population are lacking. Good quality estimates of cancer cachexia in general and for each of the major cancer types would be highly relevant for potential treatment development efforts in this field. Both the USA and European Union (EU) have implemented special clinical development rules for such rare disorders what are called 'orphan diseases'. The cut-off level for a disease to be considered an orphan disease in the USA is 200 000 people (0.06% of the population) and EU is 5 per 10 000 people (0.05% of the population). METHODS For this systematic review, we searched at PubMed (from inception to 31 January 2018) to identify clinical studies that assessed the prevalence of cachexia in cancer patients at risk. Studies reporting the prevalence of either cancer cachexia or wasting disease in the top-10 cancer types and 4 other selected cancer types known to be particularly commonly complicated by cachexia were included in this analysis (i.e. prostate cancer, breast cancer, colorectal cancer, melanoma, endometrial cancer, thyroid cancer, urinary bladder cancer, non-hodgkin lymphoma, lung cancer, kidney and renal pelvis cancer, head and neck cancer, gastric cancer, liver cancer, and pancreatic cancer). We calculated the current burden of cancer cachexia, disease by disease, in the USA and in the EU and compared them to the current guidelines for the definition of orphan disease status. RESULTS We estimate that in 2014 in the USA, a total of 527 100 patients (16.5 subjects per 10 000 people of the total population), and in 2013 in the EU, a total of 800 300 patients (15.8 subjects per 10 000 people of the total population) suffered from cancer cachexia (of any kind). In the 14 separately analysed cancer types, the prevalence of cancer cachexia in the USA ranged between 11 300 (0.4/10 000, gastric cancer) and 92 000 patients (2.9/10 000, lung cancer) and in the EU between 14 300 (0.3/10 000, melanoma of the skin) and 150 100 (3.0/10 000, colorectal cancer). CONCLUSIONS The absolute number of patients affected by cancer cachexia in each cancer group is lower than the defined thresholds for orphan diseases in the USA and EU. Cancer cachexia in each subgroup separately should be considered an orphan disease.
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Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | | | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, DZHK (German Center for Cardiovascular Research), University of Göttingen Medical Center (UMG), Göttingen, Germany
| | - Wilhelm Haverkamp
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | | | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63104, USA
| | - Florian Strasser
- Oncological Palliative Medicine, Clinic Medical Oncology and Haematology, Department of Internal Medicine, Cantonal Hospital, St Gallen and Integrated Cancer Rehabilitation, Klinik Gais, Switzerland
| | - Ulf Landmesser
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin Institute of Health (BIH), Berlin, Germany.,Department of Cardiology Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany
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Hohendanner F, Heinzel FR, Blaschke F, Pieske BM, Haverkamp W, Boldt HL, Parwani AS. Pathophysiological and therapeutic implications in patients with atrial fibrillation and heart failure. Heart Fail Rev 2019; 23:27-36. [PMID: 29038991 DOI: 10.1007/s10741-017-9657-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure and atrial fibrillation are common and responsible for significant mortality of patients. Both share the same risk factors like hypertension, ischemic heart disease, diabetes, obesity, arteriosclerosis, and age. A variety of microscopic and macroscopic changes favor the genesis of atrial fibrillation in patients with preexisting heart failure, altered subcellular Ca2+ homeostasis leading to increased cellular automaticity as well as concomitant fibrosis that are induced by pressure/volume overload and altered neurohumoral states. Atrial fibrillation itself promotes clinical deterioration of patients with preexisting heart failure as atrial contraction significantly contributes to ventricular filling. In addition, atrial fibrillation induced tachycardia can even further compromise ventricular function by inducing tachycardiomyopathy. Even though evidence has been provided that atrial functions significantly and independently of confounding ventricular pathologies, correlate with mortality of heart failure patients, rate and rhythm controls have been shown to be of equal effectiveness in improving mortality. Yet, it also has been shown that cohorts of patients with heart failure benefit from a rhythm control concept regarding symptom control and hospitalization. To date, amiodarone is the most feasible approach to restore sinus rhythm, yet its use is limited by its extensive side-effect profile. In addition, other therapies like catheter-based pulmonary vein isolation are of increasing importance. A wide range of heart failure-specific therapies are available with mixed impact on new onset or perpetuation of atrial fibrillation. This review highlights pathophysiological concepts and possible therapeutic approaches to treat patients with heart failure at risk for or with atrial fibrillation.
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Affiliation(s)
- Felix Hohendanner
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. .,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany.
| | - F R Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - F Blaschke
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - B M Pieske
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center, 13353, Berlin, Germany
| | - W Haverkamp
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - H L Boldt
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - A S Parwani
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
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Hornung J, Kuhlmann SL, Radzimanowski M, Jörgens S, Haverkamp W, Martus P, Ströhle A, Waltenberger J, Arolt V, Müller-Nordhorn J, Rieckmann N. Depressive symptoms and health care within 30 days after discharge from a cardiac hospital unit. Gen Hosp Psychiatry 2019; 56:19-27. [PMID: 30530266 DOI: 10.1016/j.genhosppsych.2018.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the association between depressive symptoms in CHD patients and in- and outpatient health care utilization during the 30 days following treatment in a cardiac hospital unit. METHOD The study sample consisted of 949 CHD patients who completed a measure of depressive symptom severity (the Patient Health Questionnaire [PHQ-9]). Cardiac disease severity and medical comorbidities were assessed by chart review. Follow-up questionnaires were mailed to patients assessing in- and outpatient health care. RESULTS Among patients with elevated depressive symptoms (PHQ-9 score of ≥7), 19.9% had at least one outpatient hospital visit (hospital-based medical centers, outpatient clinics, and emergency departments) within the first 30 days after the initial hospitalization, compared to 11.8% of patients without depressive symptoms (p = 0.002). This association remained significant after adjustment for sociodemographic and medical covariates. Elevated depressive symptoms also predicted a higher number of outpatient physician visits (adjusted OR = 2.36; 95% CI 1.75 - 3.18; p < 0.001). Results were similar for the PHQ-9 continuous score. There was no association between depressive symptoms and re-hospitalizations. CONCLUSIONS After hospitalization for cardiac care, patients with elevated depressive symptoms may be at higher risk for utilizing outpatient physician and outpatient hospital care. This is not explained by more severe cardiac disease or more comorbidities.
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Affiliation(s)
- Jakob Hornung
- Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Stella Linnea Kuhlmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Division of Emergency and Acute Medicine (CVK, CCM), Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
| | - Maria Radzimanowski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
| | - Silke Jörgens
- Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Wilhelm Haverkamp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Peter Martus
- Institute for Epidemiology and Applied Biometry, University of Tübingen, Silcherstraße 5, 72076 Tübingen, Germany.
| | - Andreas Ströhle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charitéplatz 1, 10117 Berlin, Germany.
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Jacqueline Müller-Nordhorn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
| | - Nina Rieckmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health, Seestraße 73, 13347 Berlin, Germany.
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Morris DA, Belyavskiy E, Aravind-Kumar R, Kropf M, Frydas A, Braunauer K, Marquez E, Krisper M, Lindhorst R, Osmanoglou E, Boldt LH, Blaschke F, Haverkamp W, Tschöpe C, Edelmann F, Pieske B, Pieske-Kraigher E. Potential Usefulness and Clinical Relevance of Adding Left Atrial Strain to Left Atrial Volume Index in the Detection of Left Ventricular Diastolic Dysfunction. JACC Cardiovasc Imaging 2018; 11:1405-1415. [PMID: 29153567 DOI: 10.1016/j.jcmg.2017.07.029] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/29/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze the potential usefulness and clinical relevance of adding left atrial (LA) strain to left atrial volume index (LAVI) in the detection of left ventricular diastolic dysfunction (LVDD) in patients with preserved left ventricular ejection fraction (LVEF). BACKGROUND Recent studies have suggested that LA strain could be of use in the evaluation of LVDD. However, the potential utility and clinical significance of adding LA strain to LAVI in the detection of LVDD remains uncertain. METHODS Using 2-dimensional speckle-tracking echocardiography, we analyzed a population of 517 patients in sinus rhythm at risk for LVDD such as those with arterial hypertension, diabetes mellitus, or history of coronary artery disease and preserved LVEF. RESULTS In patients with LV diastolic alterations and estimated elevated LV filling pressures, the rate of abnormal LA strain was significantly higher than an abnormal LAVI (62.4% vs. 33.6%, p < 0.01). In line with this, in patients with normal LAVI, high rates of LV diastolic alterations and abnormal LA strain were present (rates 80% and 29.4%, respectively). In agreement with these findings, adding LA strain to LAVI in the current evaluation of LVDD increased significantly the rate of detection of LVDD (relative and absolute increase 73.3% and 9.9%; rate of detection of LVDD: from 13.5% to 23.4%; p < 0.01). Regarding the clinical relevance of these findings, an abnormal LA strain (i.e., <23%) was significantly associated with worse New York Heart Association functional class, even when LAVI was normal. Moreover, in a retrospective post hoc analysis an abnormal LA strain had a significant association with the risk of heart failure hospitalization at 2 years (odds ratio: 6.6 [95% confidence interval: 2.6 to 16.6]) even adjusting this analysis for age and sex and in patients with normal LAVI. CONCLUSIONS The findings from this study provide important insights regarding the potential usefulness and clinical relevance of adding LA strain to LAVI in the detection of LVDD in patients with preserved LVEF.
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Münkler P, Wutzler A, Attanasio P, Huemer M, Parwani AS, Haverkamp W, Meyer C, Boldt LH. Ventricular Tachycardia (VT) Storm After Cryoballoon-Based Pulmonary Vein Isolation. Am J Case Rep 2018; 19:1078-1082. [PMID: 30201947 PMCID: PMC6142718 DOI: 10.12659/ajcr.908999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Following catheter ablation of atrial fibrillation, increased incidence of ventricular arrhythmia has been observed. We report a case of sustained ventricular arrhythmia in a patient who underwent cryoballoon-based pulmonary vein isolation for symptomatic persistent atrial fibrillation. CASE REPORT A 57-year-old patient with dilated cardiomyopathy underwent CB-based pulmonary vein isolation for symptomatic persistent AF. On the day following an uneventful procedure, the patient for the first time experienced a sustained ventricular tachycardia that exacerbated into VT storm. Each arrhythmia was terminated by the ICD that had been implanted for primary prevention. Antiarrhythmic treatment with amiodarone was initiated immediately. The patient remained free from sustained ventricular arrhythmia during follow-up. CONCLUSIONS After pulmonary vein isolation, physicians should be vigilant for ventricular arrhythmia. The influence of atrial autonomic innervation on ventricular electrophysiology is largely unknown.
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Affiliation(s)
- Paula Münkler
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Department of Cardiology - Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Wutzler
- Cardiovascular Center, St. Josef-Hospital, University Hospital of the Ruhr-University of Bochum, Bochum, Germany
| | - Philipp Attanasio
- Department of Internal Medicine and Cardiology, Charité - Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Abdul Shokor Parwani
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Lacour P, Parwani A, Huemer M, Attanasio P, Dang PL, Luebcke J, Schleussner L, Blaschke D, Boldt LH, Pieske B, Haverkamp W, Blaschke F. What physicians do in case of a failure of the pace-sense part of a defibrillation lead : Survey in Germany, Austria and Switzerland. Herz 2018; 45:362-368. [PMID: 30054714 DOI: 10.1007/s00059-018-4736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/14/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead. METHODS We conducted a Web-based survey across cardiac implantable electronic device (CIED) centers to investigate their procedural practice and decision-making process in cases of failure of the P/S portion of defibrillation leads. In particular, we focused on the question of whether the integrity of the HV circuit is confirmed by a test shock before decision-making. The questionnaire included 14 questions and was sent to 951 German, 341 Austrian, and 120 Swiss centers. RESULTS The survey was completed by 183 of the 1412 centers surveyed (12.7% response rate). Most centers (90.2%) do not conduct a test shock to confirm the integrity of the HV circuit before decision-making. Procedural practice in lead management varies depending on the presentation of lead failure and whether the center applies a test shock. In centers that do not conduct a test shock, the majority (69.9%) implant a new HV-P/S lead. Most centers (61.7%) that test the integrity of the HV system implant a P/S lead. The majority of centers favor DF-4 connectors (74.1%) over DF-1 connectors (25.9%) at first CIED implantation. CONCLUSION Either implanting a new HV-P/S lead or placing an additional P/S lead are selected strategies if the implantable cardioverter-defibrillator lead failure is localized to the P/S portion. However, conducting a test shock to confirm the integrity of the HV component is rarely performed.
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Affiliation(s)
- P Lacour
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Parwani
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Huemer
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Attanasio
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P L Dang
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Luebcke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Schleussner
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L-H Boldt
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - B Pieske
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - W Haverkamp
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Blaschke
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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48
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Guelker JE, Bufe A, Klues H, Shin DI, Blockhaus C, Gabriel NH, Haverkamp W, Kroeger K. Trends in Atrial Fibrillation and Prescription of Oral Anticoagulants and Embolic Strokes in Germany. Cardiovasc Revasc Med 2018; 20:399-402. [PMID: 30115560 DOI: 10.1016/j.carrev.2018.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of the study was to compare trends in frequency of atrial fibrillation (AF) with the prescription rates of oral anticoagulants (OAC) and the incidence of embolic stroke (ES) from 2005 through 2014. METHODS Annual numbers of hospitalized patients with AF and ES were extracted from the Federal Bureau of Statistics. Defined daily doses (DDD) of prescribed OAC among outpatients were extracted from the insurance drug information system. RESULTS The number of cases hospitalized with the diagnosis AF increased continuously by 78.3% (1.25 Million in 2005 to 2.19 Million in 2014, p < 0.001), likewise frequency of ES increased by 89.0% (from 46,068 to 87,050, p < 0.001) and the number of prescribed DDD of OAC almost doubled by 105.4% (from 271,328 to 557,281, p < 0.001). There is an almost linear correlation between occurrence of AF and ES (R2 = 0.9683). In contrast association between prescription rate of OAC and incidence of ES is not linear as there was a disproportional increase in OAC prescriptions beginning in the year 2010 that is not accompanied by a reduction of cases hospitalized with ES. CONCLUSIONS Our analysis of drug treatment rates for OAC in outpatients and hospitalization rates for ES revealed a disproportional increase in prescription of OAC beginning in the year 2010 that does not affect the number of cases hospitalized with ES.
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Affiliation(s)
- Jan-Erik Guelker
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Germany.
| | - Alexander Bufe
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Germany; University of Witten/Herdecke, Germany
| | - Heinrich Klues
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Germany
| | - Dong-In Shin
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Germany
| | - Christian Blockhaus
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Germany
| | | | - Wilhelm Haverkamp
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | - Knut Kroeger
- Department of Vascular Medicine, Helios Clinic Krefeld, Germany
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Huemer M, Becker AK, Wutzler A, Attanasio P, Parwani AS, Lacour P, Boldt LH, Pieske B, Haverkamp W, Blaschke F. Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation. Cardiol J 2018; 26:36-46. [PMID: 29399750 DOI: 10.5603/cj.a2018.0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/12/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplainedsyncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion. METHODS One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. RESULTS The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2-350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035). CONCLUSIONS Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation.
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Affiliation(s)
- Martin Huemer
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Ann-Kristin Becker
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Alexander Wutzler
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Philipp Attanasio
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Abdul S Parwani
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Philipp Lacour
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany
| | - Florian Blaschke
- Department of Cardiology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Germany.
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Boldt LH, Lacour P, Pieske B, Haverkamp W, Blaschke F. First-in-human: leadless Micra transcatheter pacing system meets the Nanostim leadless cardiac pacing system. Europace 2018; 20:391. [PMID: 29016787 DOI: 10.1093/europace/eux231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leif-Hendrik Boldt
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Phillip Lacour
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Florian Blaschke
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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