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103. Relation of mechanical dyssynchrony with underlying cardiac structure and performance in chronic systolic heart failure: implications on clinical response to cardiac resynchronization

Author

Tang, W. H. W., primary, Mullens, W., additional, Borowski, A. G., additional, Tong, W., additional, Shrestha, K., additional, Troughton, R. W., additional, Martin, M. G., additional, Kassimatis, K., additional, Agler, D., additional, Jasper, S., additional, Grimm, R. A., additional, Starling, R. C., additional, and Klein, A. L., additional

Published
2008
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123. Endomyocardial upregulation of ß1 adrenoreceptor gene expression and myocardial contractile reserve following cardiac resynchronization therapy.

Author

Vanderheyden M, Mullens W, Delrue L, Goethals M, Verstreken S, Wijns W, de Bruyne B, and Bartunek J

Abstract

BACKGROUND: Congestive heart failure (CHF) is associated with a blunted force-frequency relation (FFR) and myocardial contractile reserve (MCR) partially from a downregulation of beta1-adrenoreceptors (beta1-AR). We investigated whether acute and chronic cardiac resynchronization therapy (CRT) was capable of reversing the blunted FFR and MCR and if this was associated with upregulation of beta1-AR. METHODS AND RESULTS: Left ventricle dP/dtmax was invasively measured in 10 CHF patients (New York Heart Association class > or =3; ejection fraction <25%) during incremental dual chamber (DDD)-CRT pacing at 70, 90, 110, and 130 beats/min, with and without continuous infusion of intravenous dobutamine, immediately after CRT implantation (BL) and 4 months later (FU). In a subgroup of 5 patients, serial left ventricle beta1 and beta2-AR gene expression was measured using reverse transcriptase-polymerase chain reaction. Four months after the initiation of resynchronization therapy, DDD-CRT pacing results in a significant upward shift of the heart rate versus LV dP/dtmax relationship (P < .01) with force frequency amplification as evidenced by the steeper slope of the force frequency response (P = .04). Infusion of dobutamine recruits myocardial contractile reserve and increases the heart rate versus LV dP/dtmax relationship at BL and at FU (both P < .05). However, only at follow-up was an additional force frequency amplification noticed (P < .05) during dobutamine infusion. This observation was paralleled by a significant upregulation of beta1-AR gene expression (P = .02). CONCLUSIONS: Chronic CRT is associated with a partial restoration of the FFR and with a recruitment in myocardial contractile reserve, which is paralleled by upregulation of beta1-AR. [ABSTRACT FROM AUTHOR]

Published
2008
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124. Myocardial gene expression in heart failure patients treated with cardiac resynchronization therapy responders versus nonresponders.

Author

Vanderheyden M, Mullens W, Delrue L, Goethals M, de Bruyne B, Wijns W, Geelen P, Verstreken S, Wellens F, Bartunek J, Vanderheyden, Marc, Mullens, Wilfried, Delrue, Leen, Goethals, Marc, de Bruyne, Bernard, Wijns, William, Geelen, Peter, Verstreken, Sofie, Wellens, Francis, and Bartunek, Jozef

Abstract

Objectives: We studied whether functional improvement after cardiac resynchronization therapy (CRT) is associated with reversal of the heart failure (HF) gene program. Background: Cardiac resynchronization therapy improves exercise tolerance and survival in patients with advanced congestive HF and dyssynchrony. Methods: Twenty-four patients referred for CRT underwent left ventricular (LV) endomyocardial biopsies immediately before CRT implantation (baseline). In addition, 17 of them underwent LV endomyocardial biopsy procurement 4 months later (follow-up). In 6 control patients with normal LV function, LV biopsies were obtained at the time of coronary artery bypass grafting. The LV messenger ribonucleic acid (mRNA) levels of contractile and calcium regulatory genes were measured by quantitative real time polymerase chain reaction and normalized for glyceraldehyde 3-phosphate dehydrogenase (GAPDH). The HF patients showing an improvement in New York Heart Association (NYHA) functional class by >1 score and a relative increase in LV ejection fraction > or =25% at 4 months after CRT were considered as responders. Results: The HF patients were characterized by lower LV mRNA levels of alpha-myosin heavy chain (alpha-MHC), beta-myosin heavy chain (beta-MHC), sarcoplasmic reticulum calcium ATPase 2alpha (SERCA), phospholamban (PLN), and higher brain natriuretic peptide (BNP) mRNA levels as compared with control subjects. Responders to CRT (n = 11) showed an increase in LVEF (p < 0.001), a decrease in left ventricular end-diastolic diameter (p = 0.003), and NYHA functional class (p = 0.002), and a reduction in N-terminal proBNP levels (p = 0.032) as compared with baseline. This was associated with an increase in mRNA levels of alpha-MHC (p = 0.035), SERCA (p = 0.032), a decrease in BNP mRNA levels (p = 0.002), and an increase in the ratio of alpha-/beta-MHC (p = 0.018) and SERCA/PLN (p = 0.012). No significant changes in molecular profile were observed in nonresponders. Conclusions: In HF patients with electromechanical cardiac dyssynchrony, functional improvement related to CRT is associated with favorable changes in established molecular markers of HF, including genes that regulate contractile function and pathologic hypertrophy. [ABSTRACT FROM AUTHOR]

Published
2008
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125. Early and late effects of cardiac resynchronization therapy on force-frequency relation and contractility regulating gene expression in heart failure patients.

Author

Mullens W, Bartunek J, Wilson Tang WH, Delrue L, Herbots L, Willems R, De Bruyne B, Goethals M, Verstreken S, Vanderheyden M, Mullens, Wilfried, Bartunek, Jozef, Tang, W H Wilson, Delrue, Leen, Herbots, Lieven, Willems, Rik, De Bruyne, Bernard, Goethals, Marc, Verstreken, Sofie, and Vanderheyden, Marc

Abstract

Background: Heart failure is associated with a reduction in left ventricular (LV) contractility as evidenced by a blunted force-frequency response (FFR) and downregulation of contractility regulating genes.Objective: This study sought to investigate whether cardiac resynchronization therapy (CRT) is capable of reversing the blunted FFR and the downregulation of contractility regulating genes.Methods: Twenty heart failure patients underwent echocardiographic examination during incremental AAI and DDD-CRT pacing at 70, 90, and 110 beats/min, immediately after and 4 months after CRT implantation. The FFR was determined from the ratio of the LV systolic pressure/end systolic volume index at given heart rate. In a subgroup of 6 patients with idiopathic dilated cardiomyopathy, serial LV dP/dtmax was invasively measured during both pacing modes and serial LV endomyocardial biopsies were taken to measure sarcoplasmatic reticulum calcium ATPase 2alpha (SERCA2alpha), phospholamban (PLN), sarcolemmal sodium calcium exchanger (NCX), beta1-adrenoreceptor (beta1-AR), and apelin (APL) gene expression using reverse-transcriptase polymerase chain reaction.Results: Acutely, DDD-CRT pacing was associated with a decrease in dyssynchrony (P <.01) and increase in diastolic filling time (P <.01) at all heart rates paralleled by an upward shift of the FFR (P <.01) without force-frequency amplification. A greater upward shift of the FFR was noticed during DDD-CRT as compared with AAI (P <.01) after 4 months. In addition, CRT was associated with a significant force-frequency amplification at follow-up as evidenced from the steeper slope of the FFR relationship (P = .039). This was associated with a significant upregulation of SERCA2alpha P = .01), PLN (P = .01), their ratio (P = .01), ratio of SERCA/NCX (P = .02), beta1-AR (P = .03), and APL (P = .01) mRNA levels.Conclusion: CRT is associated with an acute upward shift in the FFR without force-frequency amplification related to restored synchronicity and increased filling time of the LV. Only chronic CRT is associated with force-frequency amplification in parallel to upregulation of contractility regulating genes. [ABSTRACT FROM AUTHOR]

Published
2008
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129. Epidemiology, pathophysiology and contemporary management of cardiogenic shock - a position statement from the Heart Failure Association of the European Society of Cardiology (vol 22, pg 1315, 2020)

Author

Chioncel, O., Parissis, J., Mebazaa, A., Thiele, H., Desch, S., Bauersachs, J., Harjola, V-P, Antohi, E-L, Arrigo, M., Gal, T. B., Celutkiene, J., Collins, S. P., Debacker, D., Iliescu, V. A., Jankowska, E., Jaarsma, T., Keramida, K., Lainscak, M., Lund, L. H., Lyon, A. R., Masip, J., Metra, M., Miro, O., Mortara, A., Mueller, C., Mullens, W., Nikolaou, M., Massimo Piepoli, Price, S., Rosano, G., Vieillard-Baron, A., Weinstein, J. M., Anker, S. D., Filippatos, G., Ruschitzka, F., Coats, A. J. S., and Seferovic, P.

130. Response and Tolerance to Oral Vasodilator Uptitration after Intravenous Vasodilator Therapy in Advanced Decompensated Heart Failure

Author

Tang, W. H. W., Starling, R. C., Young, J. B., Taylor, D. O., Mullens, W., Hawwa, N., Gabi, A., Finucan, M., Dupont, M., Frederik Verbrugge, Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, and Intensive Care

Subjects
Heart Failure, Male, Dose-Response Relationship, Drug, Vasodilator Agents, Hemodynamics, Advanced Decompensated Heart Failure, Middle Aged, Heart Failure/drug therapy, Oral Vasodilator Uptitration, Article, Intravenous Vasodilator Therapy, Hemodynamics/drug effects, Treatment Outcome, Vasodilator Agents/administration & dosage, Injections, Intravenous, Humans, Female, Cardiology and Cardiovascular Medicine, Follow-Up Studies, Retrospective Studies
Abstract

AIMS: The aim of this study was to assess the haemodynamic response and tolerance to aggressive oral hydralazine/isosorbide dinitrate (HYD/ISDN) up-titration after intravenous vasodilator therapy in advanced decompensated heart failure (ADHF). METHODS AND RESULTS: Medical records of 147 consecutive ADHF patients who underwent placement of a pulmonary artery catheter and received intravenous vasodilator therapy were reviewed. Intravenous sodium nitroprusside and sodium nitroglycerin as first-line agent for those with preserved blood pressures were utilized in 143 and 32 patients, respectively. Sixty-one percent of patients were converted to oral HYD/ISDN combination therapy through a standardized conversion protocol. These patients had a significantly higher admission mean pulmonary arterial wedge pressure compared with patients not converted (28 ± 7 vs. 25 ± 8 mmHg, respectively; P-value 0.024). Beneficial haemodynamic response to decongestive therapy, defined as low cardiac filling pressures and cardiac index ≥2.20 L/min/m(2) without emergent hypotension, was achieved in 32% and 29% of patients who did or did not receive oral HYD/ISDN, respectively (P-value 0.762). HYD/ISDN dosing was progressively and consistently decreased up to the moment of hospital discharge and during outpatient follow-up, primarily due to incident hypotension. CONCLUSION: The use of a standardized haemodynamically guided up-titration protocol for conversion from intravenous to oral vasodilators may warrant subsequent dose reductions upon stabilization.

133. Do acetazolamide and spironolactone increase natriuresis in congestive heart failure?

Author

Mullens, W., Droogne, W., Tang, W. H. W., Dupont, M., Penders, J., Haemels, V., Ameloot, K., Martens, P., Frederik Verbrugge, Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, and Intensive Care

Subjects
Acetazolamide, CONGESTIVE HEART FAILURE, spironolactone, Natriuresis, Cardiology and Cardiovascular Medicine

134. Cardiac resynchronization therapy with versus without a defibrillator: insights from device interrogation and mode of death analysis

Author

Mullens, W., Tang, W. H., Rivero-Ayerza, M., Herendael, H., Nuyens, D., Dupont, M., Nijst, P., Frederik Verbrugge, Martens, P. Pieter, Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, Intensive Care, and Faculty of Economic and Social Sciences and Solvay Business School

Subjects
Defibrillator, CARDIAC RESYNCHRONIZATION THERAPY, Cardiology and Cardiovascular Medicine

145. IMAGES IN CARDIOLOGY: Quadrant pulmonary oedema.

Author

Keyser, J. D., Dujardin, K., and Mullens, W.

Subjects
HEART diseases, TACHYCARDIA, AORTIC valve insufficiency, PULMONARY edema, DYSPNEA, BLOOD pressure
Abstract

This article presents information on a medical case related to quadrant pulmonary oedema. A 73 year old man presented to the emergency department with a three day history of dyspnoea. He had no past medical history. On admission his blood pressure was 120/80 mmHg, heart rate 120 bpm, and respiratory rate 24 breaths per minute. Apart from sinus tachycardia, the ECG was unremarkable. An infiltrate in the upper lobe of the right lung was seen on a standard chest x ray. The echocardiogram showed a partially flailed posterior mitral leaflet caused by ruptured chordae tendinae with severe, eccentric regurgitation directed towards the right upper pulmonary vein.

Published
2005
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146. Club 35 Poster session 2: Thursday 4 December 2014, 08:30-18:00 * Location: Poster area

Author

Santos, M, Rivero, J, Mccullough, SD, Opotowsky, AR, Waxman, AB, Systrom, D, Shah, AM, Olsen, F J, Jorgensen, PG, Mogelvang, R, Jensen, JS, Fritz-Hansen, T, Bech, J, Sivertsen, J, Biering-Sorensen, T, Santoro, C, Esposito, R, Schiano Lomoriello, V, Raia, R, De Palma, D, Ippolito, R, Ierano, P, Arpino, G, De Simone, G, Galderisi, M, Cameli, M, Lisi, M, Di Tommaso, C, Solari, M, Focardi, M, Maccherini, M, Henein, M, Galderisi, M, Mondillo, S, Simova, I, Katova, T, Galderisi, M, Pauncheva, B, Vrettos, A, Dawson, D, Grigoratos, C, Papapolychroniou, C, Nihoyannopoulos, P, Danylenko, O, Kovalenko, V, Nesukay, E, Polenova, N, Titov, I, Voilliot, D, Huttin, OH, Vaugrenard, TV, Venner, CV, Sadoul, NS, Aliot, EA, Juilliere, YJ, Selton-Suty, CSS, Hamdi, I, Mahfoudhi, H, Ben Mansour, N, Dahmani, R, Lahidheb, D, Fehri, W, Haouala, H, Erken Pamukcu, H, Gerede, DM, Sorgun, M, Akbostanci, C, Turhan, S, Erol, û, Voilliot, D, Magne, JM, Dulgheru, RD, Kou, SK, Henri, CH, Caballero, LC, De Sousa, CDS, Sprynger, MS, Pierard, LP, Lancellotti, PL, Panelo, M L, Rodriguez-Fernandez, A, Escriba-Bori, S, Krol, W, Konopka, M, Burkhard, K, Jedrzejewska, I, Pokrywka, A, Klusiewicz, A, Chwalbinska, J, Dluzniewski, M, Braksator, W, Elmissiri, AM, Eid, M, Sayed, I, Awadalla, H, Schiano-Lomoriello, V, Esposito, R, Santoro, C, Lo Iudice, F, De Simone, G, Galderisi, M, Ibrahimi, P, Jashari, F, Johansson, E, Gronlund, C, Bajraktari, G, Wester, P, Henein, MY, Potluri, R, Aziz, A, Hooper, J, Mummadi, SM, Uppal, H, Asghar, O, Chandran, S, Surkova, E A, Tereshina, O V, Shchukin, U V, Rubanenko, A O, Medvedeva, E A, Hamdi, I, Mahfoudhi, H, Ben Mansour, N, Dahmani, R, Lahidheb, D, Fehri, W, Haouala, H, Krapf, L, Nguyen, V, Cimadevilla, C, Himbert, D, Brochet, E, Iung, B, Vahanian, A, Messika-Zeitoun, D, Danylenko, O, Kovalenko, V, Nesukay, E, Titov, I, Polenova, N, Van De Heyning, C M, Magne, J, Pierard, LA, Bruyere, PJ, Davin, L, De Maeyer, C, Paelinck, BP, Vrints, CJ, Lancellotti, P, Bertrand, PB, Groenendaels, Y, Vertessen, VJ, Mullens, W, Pettinari, M, Gutermann, H, Dion, RA, Verhaert, D, Vandervoort, PM, Guven, S, Sen, T, Tufekcioglu, O, Gucuk, E, Uygur, B, Kahraman, E, Valuckiene, Z, Jurkevicius, R, Pranevicius, R, Marcinkeviciene, J, Zaliaduonyte-Peksiene, D, Stoskute, N, and Zaliunas, R

Abstract

Introduction: Among patients with unexplained dyspnea, left ventricular (LV) filling pressures (LVFP) is commonly estimated non-invasively by the E/e' ratio using Doppler echocardiography. However the accuracy of E/e' is controversial. We evaluated the correlation of E/e' ratio with invasively measured LVFP and of change in E/e' (ΔE/e') with change in LVFP. Methods: Supine and upright transthoracic echocardiography was performed in patients with unexplained dyspnea undergoing right heart catheterization. Patients with significant valvular disease and reduced LV ejection fraction (LVEF < 50%) were excluded. Pulmonary artery wedge pressure (PAWP) was used as the invasive indicator of LVFP. The mean of septal and lateral e' velocities was used for the calculation of E/e' ratio. Results: We studied 98 subjects with a mean age of 52 ± 20 years (69% of female gender). The supine E/e' and PAWP were 9.2 ± 3.2 and 12.1 ± 4.9 mmHg (range: 4-27 mmHg) respectively and were modestly correlated (r=0.38; p<0.001). With position change (supine to upright), ΔPAWP was -5.1 ± 4.3 mmHg and ΔE/e' was 0.17 ± 2.6, with no significant association between these two measures (r=0.003; p=0.98). Both E-wave (80 ± 22 to 65 ± 22 cm/s) and mean average e' (10.2 ± 3.6 to 7.3 ± 2.0 cm/s) decreased with the upright position. The ΔPAWP was correlated with ΔE-wave velocity (r=0.33; p=0.01), but not with Δe' (r=0.14; p=0.26). Conclusions: In patients with unexplained dyspnea and a preserved LVEF, E/e' is modestly, though significantly, correlated with PAWP. ΔE/e' is not correlated with ΔPAWP, partially related to the preload sensitivity of e'. Figure Figure 1 - Supine and delta E/e' plotted

Published
2014
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147. Poster session Wednesday 11 December all day display: 11/12/2013, 09:30-16:00 * Location: Poster area

Author

Bertrand, PB, Grieten, L, Smeets, C, Verbrugge, FH, Mullens, W, Vrolix, M, Rivero-Ayerza, M, Verhaert, D, Vandervoort, P, Tong, L, Ramalli, A, Tortoli, P, Dhoge, J, Bajraktari, G, Lindqvist, P, Henein, MY, Obremska, M, Boratynska, MB, Kurcz, JK, Zysko, DZ, Baran, TB, Klinger, MK, Darahim, K, Mueller, H, Carballo, D, Popova, N, Vallee, J-P, Floria, M, Chistol, R, Tinica, G, Grecu, M, Rodriguez Serrano, M, Osa-Saez, A, Rueda-Soriano, J, Buendia-Fuentes, F, Domingo-Valero, D, Igual-Munoz, B, Alonso-Fernandez, P, Quesada-Carmona, A, Miro-Palau, V, Palencia-Perez, M, Bech-Hanssen, O, Polte, CL, Lagerstrand, K, Janulewicz, M, Gao, S, Erdogan, E, Akkaya, M, Bacaksiz, A, Tasal, A, Sonmez, O, Turfan, M, Kul, S, Vatankulu, MA, Uyarel, H, Goktekin, O, Mincu, RI, Magda, LS, Mihaila, S, Florescu, M, Mihalcea, D, Enescu, OE, Chiru, A, Popescu, B, Tiu, C, Vinereanu, D, 112/2011, Research grant, Broch, K, Kunszt, G, Massey, R, De Marchi, SF, Aakhus, S, Gullestad, L, Urheim, S, Yuan, L, Feng, JL, Jin, XY, Bombardini, T, Casartelli, M, Simon, D, Gaspari, MG, Procaccio, F, Hasselberg, NE, Haugaa, KH, Brunet, A, Kongsgaard, E, Donal, E, Edvardsen, T, Sahin, TAYLAN, Yurdakul, S, Cengiz, BETUL, Bozkurt, AYSEN, Aytekin, SAIDE, Cesana, F, Spano, F, Santambrogio, G, Alloni, M, Vallerio, P, Salvetti, M, Carerj, S, Gaibazzi, N, Rigo, F, Moreo, A, Group, APRES Collaborative, Wdowiak-Okrojek, K, Michalski, B, Kasprzak, JD, Shim, A, Lipiec, P, Generati, G, Pellegrino, M, Bandera, F, Donghi, V, Alfonzetti, E, Guazzi, M, Marcun, R, Stankovic, I, Farkas, J, Vlahovic-Stipac, A, Putnikovic, B, Kadivec, S, Kosnik, M, Neskovic, AN, Lainscak, M, Iliuta, L, Szymanski, P, Lipczynska, M, Klisiewicz, A, Sobieszczanska-Malek, M, Zielinski, T, Hoffman, P, Gjerdalen, G F, Hisdal, J, Solberg, EE, Andersen, TE, Radunovic, Z, Steine, K, Svanadze, A, Poteshkina, N, Krylova, N, Mogutova, P, Shim, A, Kasprzak, JD, Szymczyk, E, Wdowiak-Okrojek, K, Michalski, B, Stefanczyk, L, Lipiec, P, Benedek, T, Matei, C, Jako, B, Suciu, ZS, Benedek, I, Yaroshchuk, N A, Kochmasheva, V V, Dityatev, V P, Kerbikov, O B, Przewlocka-Kosmala, M, Orda, A, Karolko, B, Mysiak, A, Kosmala, W, Rechcinski, T, Wierzbowska-Drabik, K, Lipiec, P, Chmiela, M, Kasprzak, JD, Aziz, A, Hooper, J, Rayasamudra, S, Uppal, H, Asghar, O, Potluri, R, Zaroui, A, Mourali, MS, Rezine, Z, Mbarki, S, Jemaa, M, Aloui, H, Mechmeche, R, Farhati, A, Gripari, P, Maffessanti, F, Tamborini, G, Muratori, M, Fusini, L, Vignati, C, Bartorelli, AL, Alamanni, F, Agostoni, PG, Pepi, M, Ruiz Ortiz, M, Mesa, D, Delgado, M, Seoane, T, Carrasco, F, Martin, M, Mazuelos, F, Suarez De Lezo Herreros De Tejada, J, Romero, M, Suarez De Lezo, J, Brili, S, Stamatopoulos, I, Misailidou, M, Chrisochoou, C, Christoforatou, E, Stefanadis, C, Ruiz Ortiz, M, Mesa, D, Delgado, M, Martin, M, Seoane, T, Carrasco, F, Ojeda, S, Segura, J, Pan, M, Suarez De Lezo, J, Cammalleri, V, Ussia, GP, Muscoli, S, Marchei, M, Sergi, D, Mazzotta, E, Romeo, F, Igual Munoz, B, Bel Minguez, ABM, Perez Guillen, MPG, Maceira Gonzalez, AMG, Monmeneu Menadas, JVMM, Hernandez Acuna, CHA, Estornell Erill, JEE, Lopez Lereu, PLL, Francisco Jose Valera Martinez, FJVM, Montero Argudo, AMA, Sunbul, M, Akhundova, A, Sari, I, Erdogan, O, Mutlu, B, Cacicedo, A, Velasco Del Castillo, S, Anton Ladislao, A, Aguirre Larracoechea, U, Rodriguez Sanchez, I, Subinas Elorriaga, A, Oria Gonzalez, G, Onaindia Gandarias, J, Laraudogoitia Zaldumbide, E, Lekuona Goya, I, Ding, W, Zhao, Y, Lindqvist, P, Nilson, J, Winter, R, Holmgren, A, Ruck, A, Henein, MY, Attenhofer Jost, C H, Soyka, R, Oxenius, A, Kretschmar, O, Valsangiacomo Buechel, ER, Greutmann, M, Weber, R, Keramida, K, Kouris, N, Kostopoulos, V, Karidas, V, Damaskos, D, Makavos, G, Paraskevopoulos, K, Olympios, CD, Eskesen, K, Olsen, NT, Fritz-Hansen, T, Sogaard, P, Cameli, M, Lisi, M, Righini, FM, Curci, V, Massoni, A, Natali, B, Maccherini, M, Chiavarelli, M, Massetti, M, Mondillo, S, Mabrouk Salem Omar, A, Ahmed Abdel-Rahman, M, Khorshid, H, Rifaie, O, Santoro, C, Santoro, A, Ippolito, R, De Palma, D, De Stefano, F, Muscariiello, R, Galderisi, M, Squeri, A, Censi, S, Baldelli, M, Grattoni, C, Cremonesi, A, Bosi, S, Saura Espin, D, Gonzalez Canovas, C, Gonzalez Carrillo, J, Oliva Sandoval, MJ, Caballero Jimenez, L, Espinosa Garcia, MD, Garcia Navarro, M, Valdes Chavarri, M, De La Morena Valenzuela, G, Ryu, SK, Shin, DG, Son, JW, Choi, JH, Goh, CW, Choi, JW, Park, JY, Hong, GR, Sklyanna, O, Yuan, L, Yuan, L, Planinc, I, Bagadur, G, Ljubas, J, Baricevic, Z, Skoric, B, Velagic, V, Bijnens, B, Milicic, D, Cikes, M, Gospodinova, M, Chamova, T, Guergueltcheva, V, Ivanova, R, Tournev, I, Denchev, S, Ancona, R, Comenale Pinto, S, Caso, P, Arenga, F, Coppola, MG, Calabro, R, Neametalla, H, Boitard, S, Hamdi, H, Planat-Benard, V, Casteilla, L, Li, Z, Hagege, AA, Mericskay, M, Menasche, P, Agbulut, O, Merlo, M, Stolfo, D, Anzini, M, Negri, F, Pinamonti, B, Barbati, G, Di Lenarda, A, Sinagra, G, Stolfo, D, Merlo, M, Pinamonti, B, Gigli, M, Poli, S, Porto, A, Di Nora, C, Barbati, G, Di Lenarda, A, Sinagra, G, Coppola, C, Piscopo, G, Cipresso, C, Rea, D, Maurea, C, Esposito, E, Arra, C, Maurea, N, Nemes, A, Kalapos, A, Domsik, P, Forster, T, Voilliot, D, Huttin, O, Vaugrenard, T, Schwartz, J, Sellal, J-M, Aliot, E, Juilliere, Y, Selton-Suty, C, Sanchez Millan, P J, Cabeza Lainez, P, Castillo Ortiz, J, Chueca Gonzalez, EM, Gheorghe, L, Fernandez Garcia, P, Herruzo Rojas, MS, Del Pozo Contreras, R, Fernandez Garcia, M, Vazquez Garcia, R, Rosca, M, Popescu, BA, Botezatu, D, Calin, A, Beladan, CC, Gurzun, M, Enache, R, Ginghina, C, Farouk, H, Al-Maimoony, T, Alhadad, A, El Serafi, M, Abdel Ghany, M, Poorzand, H, Mirfeizi, SZ, Javanbakht, A, center, Preventive Cardiovascular care research, center, Lupus Research, sciences, Mashhad university of medical, Tellatin, S, Famoso, G, Dassie, F, Martini, C, Osto, E, Maffei, P, Iliceto, S, Tona, F, Radunovic, Z, Steine, KS, Jedrzejewska, I, Braksator, W, Krol, W, Swiatowiec, A, Sawicki, J, Kostarska-Srokosz, E, Dluzniewski, M, Maceira Gonzalez, A M, Cosin-Sales, J, Diago, JL, Aguilar, J, Ruvira, J, Monmeneu, J, Igual, B, Lopez-Lereu, MP, Estornell, J, Olszanecka, A, Dragan, A, Kawecka-Jaszcz, K, Czarnecka, D, Scholz, F, Gaudron, PD, Hu, K, Liu, D, Florescu, C, Herrmann, S, Bijnens, B, Ertl, G, Stoerk, S, Weidemann, F, Krestjyaninov, M, Razin, VA, Gimaev, RH, Bogdanovic, Z, Burazor, I, Deljanin Ilic, M, Peluso, D, Muraru, D, Cucchini, U, Mihaila, S, Casablanca, S, Pigatto, E, Cozzi, F, Punzi, L, Badano, LP, Iliceto, S, Zhdanova, E, Rameev, VV, Safarova, AF, Moisseyev, SV, Kobalava, ZD, Magnino, C, Omede, P, Avenatti, E, Presutti, D, Losano, I, Moretti, C, Bucca, C, Gaita, F, Veglio, F, Milan, A, Bellsham-Revell, H, Bell, AJ, Miller, OI, Simpson, JM, Hwang, YM, Kim, GH, Jung, MH, Woo, GH, Medicine, Department of Internal, Hospital, St.Vincents, Korea, The Catholic University of, Suwon, Division of Cardiology, Repu, Driessen, MMP, Leiner, T, Schoof, PH, Breur, JMPJ, Sieswerda, GT, Meijboom, FJ, Bellsham-Revell, H, Hayes, N, Anderson, D, Austin, BC, Razavi, R, Greil, GF, Simpson, JM, Bell, AJ, Zhao, XX, Xu, XD, Qin, YW, Szmigielski, C A, Styczynski, G, Sobczynska, M, Placha, G, Kuch-Wocial, A, Ikonomidis, I, Voumbourakis, A, Triantafyllidi, H, Pavlidis, G, Varoudi, M, Papadakis, I, Trivilou, P, Paraskevaidis, I, Anastasiou-Nana, M, Lekakis, I, Kong, WILL, Yip, JAMES, Ling, LH, Milan, A, Tosello, F, Leone, D, Bruno, G, Losano, I, Avenatti, E, Sabia, L, Veglio, F, Zaborska, B, Baran, J, Pilichowska-Paszkiet, E, Sikora-Frac, M, Michalowska, I, Kulakowski, P, Budaj, A, Mega, S, Bono, MC, De Francesco, V, Castiglione, I, Ranocchi, F, Casacalenda, A, Goffredo, C, Patti, G, Di Sciascio, G, Musumeci, F, Kennedy, M, Waterhouse, DF, Sheahan, R, Foley, DF, Mcadam, BF, Ancona, R, Comenale Pinto, S, Caso, P, Arenga, F, Coppola, MG, Calabro, R, Remme, E W, Smedsrud, M K, Hasselberg, N E, Smiseth, O A, Edvardsen, T, Halmai, L, Nemes, A, Kardos, A, Neubauer, S, Degiovanni, A, Baduena, L, Dellera, G, Occhetta, E, Marino, P, Hotchi, J, Yamada, H, Nishio, S, Bando, M, Hayashi, S, Hirata, Y, Amano, R, Soeki, T, Wakatsuki, T, Sata, M, Lamia, B, Molano, LC, Viacroze, C, Cuvelier, A, Muir, JF, Lipczynska, M, Piotr Szymanski, PS, Anna Klisiewicz, AK, Lukasz Mazurkiewicz, LM, Piotr Hoffman, PH, Van T Sant, J, Wijers, SC, Ter Horst, IAH, Leenders, GE, Cramer, MJ, Doevendans, PA, Meine, M, Hatam, N, Goetzenich, A, Aljalloud, A, Mischke, K, Hoffmann, R, Autschbach, R, Sikora-Frac, M, Zaborska, B, Maciejewski, P, Bednarz, B, Budaj, A, Evangelista, A, Torromeo, C, Pandian, NG, Nardinocchi, P, Varano, V, Schiariti, M, Teresi, L, Puddu, PE, Storve, S, Dalen, H, Snare, SR, Haugen, BO, Torp, H, Fehri, W, Mahfoudhi, H, Mezni, F, Annabi, MS, Taamallah, K, Dahmani, R, Haggui, A, Hajlaoui, N, Lahidheb, D, Haouala, H, Colombo, A, Carminati, MC, Maffessanti, F, Gripari, P, Pepi, M, Lang, RM, Caiani, EG, Walker, JR, Abadi, S, Agmon, Y, Carasso, S, Aronson, D, Mutlak, D, Lessick, J, Saxena, A, Ramakrishnan, S, Juneja, R, Ljubas, J, Reskovic Luksic, V, Matasic, R, Pezo Nikolic, B, Lovric, D, Separovic Hanzevacki, J, Quattrone, A, Zito, C, Alongi, G, Vizzari, G, Bitto, A, De Caridi, G, Greco, M, Tripodi, R, Pizzino, G, Carerj, S, Ibrahimi, P, Jashari, F, Johansson, E, Gronlund, C, Bajraktari, G, Wester, P, Henein, MY, Kosmala, W, Marwick, TH, Souza, J R M, Zacharias, L G T, Geloneze, B, Pareja, J C, Chaim, A, Nadruz, W JR, Coelho, O R, Apostolovic, S, Stanojevic, D, Jankovic-Tomasevic, R, Salinger-Martinovic, S, Djordjevic-Radojkovic, D, Pavlovic, M, Tahirovic, E, Musial-Bright, L, Lainscak, M, Duengen, HD, group, CIBIS ELD study, Filipiak, D, Kasprzak, JD, and Lipiec, P

Abstract

Purpose: With the advent of percutaneous transcatheter device closures in congenital heart defects and the emergence of percutaneous left atrial appendage closure, there is an increasingly important role for echocardiographic guidance and control of device position and function. Disc occluder devices frequently present as an unexplained ‘figure-of-8’ on echocardiography. The aim of this study was to clarify this ‘figure-of-8’ display and to relate its morphology to transducer position and device type. Methods: A mathematical model was developed to resemble disc occluder geometry and to allow a numerical simulation of the echocardiographic appearance. In addition, we developed an in vitro set-up for echocardiographic analysis of various disc occluders and various transducer positions. Results: In the mathematical model of an epitrochoid curve (closely resembling disc occluder geometry) a ‘figure-of-8’ display is obtained when emphasizing points with tangent vector perpendicular to the direction of ultrasound waves. Decreasing imaging depth results in a more asymmetric ‘figure-of-8’, with small upper part and wide lower part. Clinical and in vitro data are in close agreement with these results (Figure 1). Furthermore a ‘figure-of-8’ display is only obtained in a coronal imaging position, and is similar for different commercially available disc occluder types. Conclusions: The ‘figure-of-8’ display in the ultrasound image of a disc occluder is an imaging artifact due to the specific ‘epitrochoidal’ geometry of a deployed device and its interaction with ultrasound waves. The morphology of the ‘figure-of-8’ depends on transducer position, i.e. imaging depth, and is similar for different device types. Figure 1 Impact of imaging depth

Published
2013
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148. COVID-19 vaccination in patients with heart failure: a position paper of the Heart Failure Association of the European Society of Cardiology

Author

Wilfried Mullens, Dimitrios Farmakis, Tuvia Ben Gal, Gerasimos Filippatos, Tiny Jaarsma, Robin Ray, Ekaterini Lambrinou, Gianluigi Savarese, Carlo G. Tocchetti, Alain Cohen-Solal, Yuri N. Belenkov, Maurizio Volterrani, Stamatis Adamopoulos, Arsen D. Ristić, Brenda Moura, Amina Rakisheva, Arantxa González, Michele Senni, Finn Gustafsson, Antoni Bayes-Genis, Thomas Thum, Ovidiu Chioncel, Marco Metra, Magdy Abdelhamid, Fadi Jouhra, Y M Lopatin, Lars Lund, Giuseppe M.C. Rosano, Sophie Van Linthout, Davor Miličić, Petar M. Seferovic, Piotr Ponikowski, Andrew J.S. Coats, Mitja Lainscak, Massimo F Piepoli, Michael Böhm, Loreena Hill, Stefan D. Anker, Ewa A. Jankowska, Rosano, G, Jankowska, E, Ray, R, Metra, M, Abdelhamid, M, Adamopoulos, S, Anker, S, Bayes-Genis, A, Belenkov, Y, Gal, T, Böhm, M, Chioncel, O, Cohen-Solal, A, Farmakis, D, Filippatos, G, González, A, Gustafsson, F, Hill, L, Jaarsma, T, Jouhra, F, Lainscak, M, Lambrinou, E, Lopatin, Y, Lund, L, Milicic, D, Moura, B, Mullens, W, Piepoli, M, Ponikowski, P, Rakisheva, A, Ristic, A, Savarese, G, Seferovic, P, Senni, M, Thum, T, Tocchetti, C, Van Linthout, S, Volterrani, M, Coats, A, IRCCS San Raffaele [Rome, Italy], Wrocław Medical University, University of London [London], St George’s University Hospitals, Università degli Studi di Brescia = University of Brescia (UniBs), Civic Hospital of Brescia, Cairo University, Onassis Cardiac Surgery Center [Athens] (OCSC), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Berlin Institute of Health (BIH), Université de Barcelonne, Instituto de Salud Carlos III [Madrid] (ISC), Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain] (GTPUH), Sechenov First Moscow State Medical University, Tel Aviv University (TAU), Universität des Saarlandes [Saarbrücken], University of Medicine and Pharmacy 'Carol Davila' Bucharest (UMPCD), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Cyprus [Nicosia] (UCY), National and Kapodistrian University of Athens (NKUA), Center for Applied Medical Research [Plamplona] (CIMA), Universidad de Navarra [Pamplona] (UNAV), University of Copenhagen = Københavns Universitet (UCPH), Queen's University [Belfast] (QUB), Linköping University (LIU), University of Ljubljana, Cyprus University of Technology, Volgograd State Medical University [Russian Federation] (VSMU), Karolinska University Hospital [Stockholm], University of Zagreb, Universidade do Porto = University of Porto, Hasselt University (UHasselt), Ziekenhuis Oost-Limburg (ZOL), Università degli studi di Parma = University of Parma (UNIPR), Al-Farabi Kazakh National University [Almaty] (KazNU), University of Belgrade [Belgrade], Serbian Academy of Sciences and Arts (SASA), Azienda Ospedaliera Ospedale Papa Giovanni XXIII [Bergamo, Italy], Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), Fraunhofer Institute for Toxicology and Experimental Medicine (Fraunhofer ITEM), Fraunhofer (Fraunhofer-Gesellschaft), University of Naples Federico II = Università degli studi di Napoli Federico II, German Center for Cardiovascular Research (DZHK), University of Warwick [Coventry], leboeuf, Christophe, Publica, Rosano, G., Jankowska, E. A., Ray, R., Metra, M., Abdelhamid, M., Adamopoulos, S., Anker, S. D., Bayes-Genis, A., Belenkov, Y., Gal, T. B., Bohm, M., Chioncel, O., Cohen-Solal, A., Farmakis, D., Filippatos, G., Gonzalez, A., Gustafsson, F., Hill, L., Jaarsma, T., Jouhra, F., Lainscak, M., Lambrinou, E., Lopatin, Y., Lund, L. H., Milicic, D., Moura, B., Mullens, W., Piepoli, M. F., Ponikowski, P., Rakisheva, A., Ristic, A., Savarese, G., Seferovic, P., Senni, M., Thum, T., Tocchetti, C. G., Van Linthout, S., Volterrani, M., and Coats, A. J. S.

Subjects
medicine.medical_specialty, COVID-19 Vaccines, medicine.medical_treatment, media_common.quotation_subject, Frail Elderly, Frailty syndrome, Cardiology, Heart failure, Disease, Medical and Health Sciences, SARS‐CoV‐2, [SDV.IMM.VAC] Life Sciences [q-bio]/Immunology/Vaccinology, SDG 3 - Good Health and Well-being, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, COVID‐19, Hygiene, medicine, Humans, Intensive care medicine, media_common, Aged, Heart transplantation, HFA position paper, business.industry, SARS-CoV-2, Social distance, Vaccination, COVID-19, Iron Deficiencies, medicine.disease, failure, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Heart Failure, Position paper, Position Paper, Clinical Medicine, [SDV.IMM.VAC]Life Sciences [q-bio]/Immunology/Vaccinology, Cardiology and Cardiovascular Medicine, business
Abstract

Patients with heart failure (HF) who contract SARS-CoV-2 infection are at a higher risk of cardiovascular and non-cardiovascular morbidity and mortality. Regardless of therapeutic attempts in COVID-19, vaccination remains the most promising global approach at present for controlling this disease. There are several concerns and misconceptions regarding the clinical indications, optimal mode of delivery, safety and efficacy of COVID-19 vaccines for patients with HF. This document provides guidance to all healthcare professionals regarding the implementation of a COVID-19 vaccination scheme in patients with HF. COVID-19 vaccination is indicated in all patients with HF, including those who are immunocompromised (e.g. after heart transplantation receiving immunosuppressive therapy) and with frailty syndrome. It is preferable to vaccinate against COVID-19 patients with HF in an optimal clinical state, which would include clinical stability, adequate hydration and nutrition, optimized treatment of HF and other comorbidities (including iron deficiency), but corrective measures should not be allowed to delay vaccination. Patients with HF who have been vaccinated against COVID-19 need to continue precautionary measures, including the use of facemasks, hand hygiene and social distancing. Knowledge on strategies preventing SARS-CoV-2 infection (including the COVID-19 vaccination) should be included in the comprehensive educational programmes delivered to patients with HF. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.]

Published
2021
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149. The effect of fluid bolus administration on cerebral tissue oxygenation in post-cardiac arrest patients.

Author

Bogaerts, E., Ferdinande, B., Palmers, P.J., Malbrain, M.L.N.G., Van Regenmortel, N., Wilmer, A., Lemmens, R., Janssens, S., Nijst, P., De Deyne, C., Verhaert, D., Mullens, W., Dens, J., Dupont, M., Ameloot, K., and Malbrain, Mlng

Subjects
*OXYGEN in the blood, *CARDIAC output, *CENTRAL venous pressure, *FLUIDS, *ARREST, *LEG, *BLOOD pressure, *FLUID therapy, *ARTERIES, *CARDIAC arrest, *HEMODYNAMICS
Abstract

Purpose: Fluid boluses (FB) are often used in post-cardiac arrest (CA) patients with haemodynamic instability. Although FB may improve cardiac output (CO) and mean arterial pressure (MAP), FB may also increase central venous pressure (CVP), reduce arterial PaO2, dilute haemoglobin and cause interstitial oedema. The aim of the present study was to investigate the net effect of FB administration on cerebral tissue oxygenation saturation (SctO2) in post-CA patients.Methods: Pre-planned sub-study of the Neuroprotect post-CA trial (NCT02541591). Patients with anticipated fluid responsiveness based on stroke volume variation (SVV) or passive leg raising test were administered a FB of 500 ml plasma-lyte A (Baxter Healthcare) and underwent pre- and post-FB assessments of stroke volume, CO, MAP, CVP, haemoglobin, PaO2 and SctO2.Results: 52 patients (mean age 64 ± 12 years, 75% male) received a total of 115 FB. Although administration of a FB resulted in a significant increase of stroke volume (63 ± 22 vs 67 ± 23 mL, p = 0.001), CO (4,2 ± 1,6 vs 4,4 ± 1,7 L/min, p = 0.001) and MAP (74,8 ± 13,2 vs 79,2 ± 12,9 mmHg, p = 0.004), it did not improve SctO2 (68.54 ± 6.99 vs 68.70 ± 6.80%, p = 0.49). Fluid bolus administration also resulted in a significant increase of CVP (10,0 ± 4,5 vs 10,7 ± 4,9 mmHg, p = 0.02), but did not affect PaO2 (99 ± 31 vs 94 ± 31 mmHg, p = 0.15) or haemoglobin concentrations (12,9 ± 2,1 vs 12,8 ± 2,2 g/dL, p = 0.10). In a multivariate model, FB-induced changes in CO (beta 0,77; p = 0.004) and in CVP (beta -0,23; p = 0.02) but not in MAP (beta 0,02; p = 0.18) predicted post-FB ΔSctO2.Conclusions: Despite improvements in CO and MAP, FB administration did not improve SctO2 in post-cardiac arrest patients. [ABSTRACT FROM AUTHOR]

Published
2021
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150. Low hemoglobin levels are associated with lower cerebral saturations and poor outcome after cardiac arrest.

Author

Ameloot, K., Genbrugge, C., Meex, I., Janssens, S., Boer, W., Mullens, W., Ferdinande, B., Dupont, M., Dens, J., and De Deyne, C.

Subjects
*HEMOGLOBINS, *CARDIAC arrest, *LONGITUDINAL method, *SCIENTIFIC observation, *HYPOTHERMIA, *PULMONARY artery catheters, *THERAPEUTICS, *CEREBRAL ischemia, *PROGNOSIS, *SURVIVAL, *DISEASE incidence, *OXYGEN consumption, *DISEASE complications, BRAIN metabolism
Abstract

Purpose: Post-cardiac arrest (CA) patients have a large cerebral penumbra at risk for secondary ischemic damage in case of suboptimal brain oxygenation during ICU stay. The aims of this study were to investigate the association between hemoglobin, cerebral oxygenation (SctO2) and outcome in post-CA patients.Methods: Prospective observational study in 82 post-CA patients. Hemoglobin, a corresponding SctO2 measured by NIRS and SVO2 in patients with a pulmonary artery catheter (n=62) were determined hourly during hypothermia in the first 24h of ICU stay.Results: We found a strong linear relationship between hemoglobin and mean SctO2 (SctO2=0.70×hemoglobin+56 (R(2) 0.84, p=10(-6))). Hemoglobin levels below 10g/dl generally resulted in lower brain oxygenation. There was a significant association between good neurological outcome (43/82 patients in CPC 1-2 at 180 days post-CA) and admission hemoglobin above 13g/dl (OR 2.76, 95% CI 1.09:7.00, p=0.03) or mean hemoglobin above 12.3g/dl (OR 2.88, 95%CI 1.02:8.16, p=0.04). This association was entirely driven by results obtained in patients with a mean SVO2 below 70% (OR 6.25, 95%CI 1.33:29.43, p=0.01) and a mean SctO2 below 62.5% (OR 5.87, 95%CI 1.08:32.00, p=0.03).Conclusion: Hemoglobin levels below 10g/dl generally resulted in lower cerebral oxygenation. Average hemoglobin levels below 12.3g/dl were associated with worse outcome in patients with suboptimal SVO2 or SctO2. The safety of a universal restrictive transfusion threshold of 7g/dl can be questioned in post-CA patients. [ABSTRACT FROM AUTHOR]

Published
2015
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