Search

Your search keyword '"Kiencke, S."' showing total 2 results
Start Over Author "Kiencke, S." Publisher elsevier
2 results on '"Kiencke, S."'

1. Pre-clinical diabetic cardiomyopathy: prevalence, screening, and outcome

Author

Kiencke, S, Handschin, R, von Dahlen, R, Muser, J, Brunner-Larocca, H P, Schumann, J, Felix, B, Berneis, K, Rickenbacher, P, Kiencke, S, Handschin, R, von Dahlen, R, Muser, J, Brunner-Larocca, H P, Schumann, J, Felix, B, Berneis, K, and Rickenbacher, P

Abstract

AIMS: Diabetic cardiomyopathy, characterized by left ventricular (LV) dysfunction and LV hypertrophy independent of myocardial ischaemia and hypertension, could contribute to the increased life-time risk of congestive heart failure seen in patients with diabetes. We assessed prospectively the prevalence, effectiveness of screening methods [brain natriuretic peptide (BNP) and C-reactive protein in combination with clinical parameters], and outcome of pre-clinical diabetic cardiomyopathy. METHODS AND RESULTS: We studied 100 adults (mean age 57.4 +/- 10.2 years, 44% females) with diabetes and no previous evidence of structural heart disease. By echocardiography, diabetic cardiomyopathy was present in 48% of patients. Screening with combinations of clinical parameters (gender, systolic blood pressure, and body mass index), but not BNP, resulted in high negative predictive values for diabetic cardiomyopathy. During a mean follow-up of 48.5 +/- 9.0 months, in the groups with and without diabetic cardiomyopathy, 12.5 vs. 3.9% (P < 0.2) patients died or experienced cardiovascular events and 37.5 vs. 9.6% (P < 0.002) had a deterioration in NYHA functional class. Overall event-free survival was 54 vs. 87% (P = 0.001) in the groups with and without diabetic cardiomyopathy, respectively. Brain natriuretic peptide was an independent predictor of events [odds ratio 3.5 (1.1-10.9), P = 0.02]. CONCLUSION: Pre-clinical diabetic cardiomyopathy is common. Screening with combinations of simple clinical parameters, but not BNP, can be useful to identify those patients needing further evaluation. Patients with pre-clinical diabetic cardiomyopathy are at increased risk for functional deterioration and possibly cardiovascular events during follow-up. Brain natriuretic peptide was shown to be an independent predictor of future events.

Published
2010

2. Acute changes in pulmonary artery pressures due to exercise and exposure to high altitude do not cause left ventricular diastolic dysfunction.

Author

Bernheim AM, Kiencke S, Fischler M, Dorschner L, Debrunner J, Mairbäurl H, Maggiorini M, and Brunner-La Rocca HP

Subjects
Adult, Blood Flow Velocity, Carbolines therapeutic use, Dexamethasone therapeutic use, Diastole, Echocardiography, Doppler, Exercise Test, Female, Follow-Up Studies, Glucocorticoids therapeutic use, Humans, Hypertension, Pulmonary complications, Hypertension, Pulmonary physiopathology, Hypertension, Pulmonary prevention & control, Male, Myocardial Contraction physiology, Phosphodiesterase Inhibitors therapeutic use, Prognosis, Pulmonary Edema physiopathology, Reference Values, Rest physiology, Tadalafil, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left etiology, Altitude, Exercise physiology, Mountaineering physiology, Pulmonary Edema etiology, Pulmonary Wedge Pressure physiology, Ventricular Dysfunction, Left physiopathology
Abstract

Background: Altitude-induced pulmonary hypertension has been suggested to cause left ventricular (LV) diastolic dysfunction due to ventricular interaction. In this study, we evaluate the effects of exercise- and altitude-induced increase in pulmonary artery pressures on LV diastolic function in an interventional setting investigating high-altitude pulmonary edema (HAPE) prophylaxis., Methods: Among 39 subjects, 29 were HAPE susceptible (HAPE-S) and 10 served as control subjects. HAPE-S subjects were randomly assigned to prophylactic tadalafil (10 mg), dexamethasone (8 mg), or placebo bid, starting 1 day before ascent. Doppler echocardiography at rest and during submaximal exercise was performed at low altitude (490 m) and high altitude (4,559 m). The ratio of early transmitral inflow peak velocity (E) to atrial transmitral inflow peak velocity (A), pulmonary venous flow parameters, and tissue velocity within the septal mitral annulus during early diastole (E') were used to assess LV diastolic properties. LV filling pressures were estimated by E/E'. Systolic right ventricular to atrial pressure gradients (RVPGs) were measured in order to estimate pulmonary artery pressures., Results: At 490 m, E/A decreased similarly with exercise in HAPE-S and control subjects (HAPE-S, 1.5 +/- 0.3 to 1.3 +/- 0.3; control, 1.7 +/- 0.4 to 1.3 +/- 0.3; p = 0.12 between groups) [mean +/- SD], whereas RVPG increased significantly more in HAPE-S subjects (20 +/- 5 to 43 +/- 9 mm Hg vs 18 +/- 3 to 28 +/- 3 mm Hg, p < 0.001). Changes in RVPG levels during exercise did not correlate with changes in E/A (p > 0.1). From 490 to 4,559 m, no correlations between changes in RVPG and changes in E/A or atrial reversal (both p > 0.1) were observed. Neither of the groups showed an increase in E/E' from 490 to 4,559 m., Conclusion: Increased pulmonary artery pressure associated with exercise and acute exposure to 4,559 m appears not to cause LV diastolic dysfunction in healthy subjects. Therefore, ventricular interaction seems not to be of hemodynamic relevance in this setting.

Published
2007
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results