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8 results on '"Andreas Goldschmied"'

1. Novel 3-dimensional effective regurgitation orifice area quantification serves as a reliable tool to identify severe mitral valve regurgitation

Author

Tobias Harm, Frederic-Joaquim Schwarz, Monika Zdanyte, Andreas Goldschmied, Livia Baas, Parwez Aidery, Serhii Shcherbyna, Ioannis Toskas, Timea Keller, Isabela Kast, Juergen Schreieck, Tobias Geisler, Meinrad Paul Gawaz, and Karin Anne Lydia Mueller

Subjects
Mitral regurgitation, Effective regurgitation orifice area, 3D EROA, Three-dimensional Echocardiography, Vena Contracta Area, Diagnostic value, Medicine, Science
Abstract

Abstract A precise quantification of mitral regurgitation (MR) severity is essential for treatment and outcome of patients with MR. 3D echocardiography facilitates estimation of MR but selection of patients with necessity of invasive treatment remains challenging. We investigate effective regurgitation orifice area (EROA) quantification by 3D compared to 2D echocardiography in patients with MR and highlight the improved discrimination of MR severity. We consecutively enrolled fifty patients with primary or secondary and at least moderate MR undergoing 2D and 3D colour Doppler echocardiography prior to transcatheter edge-to-edge repair (TEER). Improved accuracy of MR grading using 3D vena contracta area (VCA) as an estimate of EROA was compared to 2D proximal isovelocity surface area (PISA) quantification method and a multiparameter reference standard. Quantification of EROA remarkably varies between 2D and 3D echocardiography and the discrimination between moderate and severe MR was significantly (p = 0.001) different using 2D PISA or 3D VCA, respectively. 3D VCA correlated significantly (r = 0.501, p

Published
2024
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2. Preclinical identification of acute coronary syndrome without high sensitivity troponin assays using machine learning algorithms

Author

Andreas Goldschmied, Manuel Sigle, Wenke Faller, Diana Heurich, Meinrad Gawaz, and Karin Anne Lydia Müller

Subjects
Preclinical ACS, Machine learning, STEMI, NSTEMI, Acute coronary occlusion, Medicine, Science
Abstract

Abstract Preclinical management of patients with acute chest pain and their identification as candidates for urgent coronary revascularization without the use of high sensitivity troponin essays remains a critical challenge in emergency medicine. We enrolled 2760 patients (average age 70 years, 58.6% male) with chest pain and suspected ACS, who were admitted to the Emergency Department of the University Hospital Tübingen, Germany, between August 2016 and October 2020. Using 26 features, eight Machine learning models (non-deep learning models) were trained with data from the preclinical rescue protocol and compared to the “TropOut” score (a modified version of the “preHEART” score which consists of history, ECG, age and cardiac risk but without troponin analysis) to predict major adverse cardiac event (MACE) and acute coronary artery occlusion (ACAO). In our study population MACE occurred in 823 (29.8%) patients and ACAO occurred in 480 patients (17.4%). Interestingly, we found that all machine learning models outperformed the “TropOut” score. The VC and the LR models showed the highest area under the receiver operating characteristic (AUROC) for predicting MACE (AUROC = 0.78) and the VC showed the highest AUROC for predicting ACAO (AUROC = 0.81). A SHapley Additive exPlanations (SHAP) analyses based on the XGB model showed that presence of ST-elevations in the electrocardiogram (ECG) were the most important features to predict both endpoints.

Published
2024
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3. Platelet miRNAs: differential expression in coronary artery disease and associations with course of left ventricular systolic function

Author

Andreas Goldschmied, Bernhard Drotleff, Stefan Winter, Elke Schaeffeler, Matthias Schwab, Meinrad Gawaz, Tobias Geisler, and Dominik Rath

Subjects
Platelet microRNA, Coronary artery disease, Myocardial infarction, MiRNA 103a-3p, MiRNA 155-5p, Left ventricular ejection fraction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background MicroRNAs are paramount in post transcriptional gene regulation. We investigated platelet miRNAs in patients with CAD and examined potential associations with course of left ventricular ejection fraction (LVEF%). Materials and methods In a first cohort, 62 MiRNAs were measured in platelets of 100 patients suffering from CAD. Expression profiles of individuals with chronic coronary syndrome (CCS) and MI were compared (CCS n = 67, MI n = 33). Also, associations between miRNA profiles and change in left ventricular ejection fraction (LVEF%) were investigated. In a second cohort of patients suffering from CCS (n = 10), MI (n = 11) or no CAD (n = 13), we measured miRNA expression in platelets, platelet supernatant and serum. This was carried out before and after in vitro platelet activation with CRP. Results Platelet miRNAs 103a-3p and 155-5p demonstrated higher expression in patients with CCS then in individuals with MI. Furthermore, multiple miRNAs were significantly higher expressed in matched controls compared to MI patients. 8 miRNAs showed higher expression in patients with improving LVEF% after a 1-year follow-up. In our second cohort, we found higher concentrations of 6 miRNAs in the platelet supernatant of patients with CCS, MI and no CAD after in vitro platelet activation. Most of these miRNAs showed a higher abundance in serum of MI patients as compared to CCS. Conclusion Several miRNAs show higher expression in platelets of CCS compared to MI. After in vitro platelet activation, a release of multiple miRNAs out of the thrombocyte was observed. Furthermore, upregulation of serum miRNAs was found in MI patients when compared to CCS patients and individuals without CAD. Hence, platelets could present a source of upregulated circulating miRNAs in MI and additionally affect course of LVEF%.

Published
2023
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4. Pacemaker Lead Entanglement during Interventional PFO Occlusion: Salvage Using a Sizing Balloon

Author

Andreas Goldschmied, Juergen Schreieck, and Michal Droppa

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

We present a case of a patient with a transient ischaemic attack (TIA) likely due to paradoxical embolism through a patent foramen ovale (PFO). Her medical history included 2nd-degree heart block Mobitz II, which manifested with recurrent syncopes and was treated with a dual chamber pacemaker. During the interventional PFO closure procedure, we noted entrapment of the atrial pacemaker lead between the right-sided occluder disc and the interatrial septum. We were able to successfully move the lead aside using a 24 mm sizing balloon and subsequently developed the right-sided occluder disc in the correct position. In conclusion, pacemaker-lead entrapment between a PFO occluder disc and the interatrial septum can be prevented using a sizing balloon.

Published
2023
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5. Statin Treatment Is Associated with Alterations in the Platelet Lipidome

Author

Tobias Harm, Moritz Frey, Kristina Dittrich, Andreas Goldschmied, Anne-Katrin Rohlfing, Xiaoqing Fu, Adrian Brun, Tatsiana Castor, Dominik Rath, Karin Müller, Michael Lammerhofer, and Meinrad Gawaz

Subjects
Hematology
Abstract

Background Platelets are key players in the pathophysiology of coronary artery disease (CAD) and platelet hyperreactivity leads to increased risk of developing adverse cardiovascular events. Further, significant changes in the platelet lipidome occur in patients with acute coronary syndrome (ACS) and critically regulated lipids lead to platelet hyperresponsiveness. Statin treatment is crucial in the treatment and prevention of patients with CAD by remodeling lipid metabolism. Objective In this study, we investigate the platelet lipidome of CAD patients by untargeted lipidomics, highlighting significant changes between statin-treated and naïve patients. Methods We characterized the platelet lipidome in a CAD cohort (n = 105) by an untargeted lipidomics approach using liquid chromatography coupled to mass spectrometry. Results Among the annotated lipids, 41 lipids were significantly upregulated in statin-treated patients, whereas 6 lipids were downregulated compared to naïve patients. The most prominent upregulated lipids in statin-treated patients belong to the class of triglycerides, cholesteryl esters, palmitic acid, and oxidized phospholipids, whereas mainly glycerophospholipids were downregulated compared to untreated patients. A more pronounced effect of statin treatment on the platelet lipidome was observed in ACS patients. We further highlight a dose-dependent influence on the platelet lipidome. Conclusion Our results reveal that the platelet lipidome is altered in CAD patients with statin treatment and upregulated lipids embody mainly characteristic triglycerides, whereas downregulated lipids mostly compromise glycerophospholipids, which may play a role in the pathophysiology of CAD. Results of this study may contribute to the understanding of statin treatment softening the lipid phenotype.

Published
2023

6. Acute coronary syndrome is associated with a substantial change in the platelet lipidome

Author

Andreas Goldschmied, Kristina Dittrich, Madhumita Chatterjee, Tatsiana Castor, Alexander Bild, Michael Lämmerhofer, Tobias Geisler, Dominik Rath, Jeremy Nestele, Tobias Harm, Xiaoqing Fu, Oliver Borst, Meinrad Gawaz, and Kyra Kolb

Subjects
Blood Platelets, medicine.medical_specialty, Acute coronary syndrome, Physiology, Coronary Artery Disease, Glycerophospholipids, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Internal medicine, medicine, Humans, Platelet, Platelet activation, Acute Coronary Syndrome, Thrombus, 030304 developmental biology, 0303 health sciences, business.industry, Thrombosis, Lipidome, medicine.disease, Lipids, Pathophysiology, Lipidomics, Cardiology, Biomarker (medicine), Cardiology and Cardiovascular Medicine, business
Abstract

Aims Platelets play a key role in the pathophysiology of coronary artery disease (CAD) and patients with enhanced platelet activation are at increased risk to develop adverse cardiovascular events. Beyond reliable cardiovascular risk factors such as dyslipoproteinaemia, significant changes of platelet lipids occur in patients with CAD. In this study, we investigate the platelet lipidome by untargeted liquid chromatography–mass spectrometry, highlighting significant changes between acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients. Additionally, we classify the platelet lipidome, spotlighting specific glycerophospholipids as key players in ACS patients. Furthermore, we examine the impact of significantly altered lipids in ACS on platelet-dependent thrombus formation and aggregation. Methods and results In this consecutive study, we characterized the platelet lipidome in a CAD cohort (n = 139) and showed significant changes of lipids between patients with ACS and CCS. We found that among 928 lipids, 7 platelet glycerophospholipids were significantly up-regulated in ACS, whereas 25 lipids were down-regulated compared to CCS. The most prominent up-regulated lipid in ACS, PC18:0 (PC 10:0-8:0), promoted platelet activation and ex vivo platelet-dependent thrombus formation. Conclusions Our results reveal that the platelet lipidome is altered in ACS and up-regulated lipids embody primarily glycerophospholipids. Alterations of the platelet lipidome, especially of medium chain lipids, may play a role in the pathophysiology of ACS.

Published
2021

7. Therapeutische Plasmapherese in der Intensivmedizin

Author

Reimer Riessen and Andreas Goldschmied

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, THYROTOXIC STORM, Medicine, 030208 emergency & critical care medicine, Therapeutic plasma exchange, General Medicine, 030204 cardiovascular system & hematology, business
Abstract

Was ist neu? Sepsis und Multiorganversagen Die Rolle der therapeutischen Plasmapherese (TP) in der Therapie der Sepsis mit Multiorganversagen ist noch nicht abschließend geklärt (Kategorie III der American Society for Apheresis, ASFA). Zwar zeigen die verfügbaren randomisiert kontrollierten Studien (RCT) keinen eindeutigen Überlebensvorteil, prospektive Daten von 2018 belegen jedoch ein gutes Sicherheitsprofil und eine günstige Beeinflussung von Surrogatparametern auch bei hoch Katecholamin-pflichtigen Patienten im septischen Schock. Akutes Leberversagen Eine multizentrische RCT von 2016 konnte einen signifikanten Überlebensvorteil durch die Durchführung von „High Volume“-TP bei Patienten im akuten Leberversagen zeigen. Dies galt allerdings nur in der Subgruppe der nicht transplantierten Patienten. Katastrophales Antiphospholipid-Antikörper-Syndrom (CAPS) Retrospektive Datenauswertungen von 2016 zeigten einen deutlichen Überlebensvorteil einer 3-Fachtherapie, welche die TP beinhaltet. Dies veranlasste die ASFA in ihren neuen, 2019 erschienenen Leitlinien das CAPS erstmals in die ASFA-Kategorie I einzustufen. Thyreotoxische Krise Retrospektive Analysen von 2018 ergaben eine effektive Elimination von Schilddrüsenhormonen durch die TP. Aufgrund dessen erkennt die ASFA in ihren neuen Leitlinien die TP als Zweitlinientherapie der thyreotoxischen Krise an.

Published
2021

8. [New aspects of therapeutic plasma exchange in critical care medicine]

Author

Andreas, Goldschmied and Reimer, Riessen

Subjects
Critical Care, Plasma Exchange, Humans, Liver Failure, Acute, Thyroid Crisis, Antiphospholipid Syndrome, Shock, Septic
Abstract

Therapeutic plasma exchange (TPE) is used to eliminate toxins, hormones or antibodies from the blood and replace the lost volume with fresh frozen plasma, albumin or crystalloids. In this article, recent advances in the usage for TPE for four different critical disease entities are explored: Septic shock, acute liver failure, catastrophic antiphospholipid syndrome (CAPS) and thyrotoxic storm.Even though randomized controlled trials have not been able to demonstrate a clear benefit of TPE in septic shock, recent data demonstrates a sufficient safety profile for usage in critically ill, highly catecholamine dependent individuals. Moreover, an improvement in several surrogate parameters has been demonstrated.High volume TPE has been shown to improve outcome in patients in acute liver failure in a multicenter, randomized controlled trial. However, this was only true for a subgroup of patients which did not receive a liver transplant. This raises the question about the effectiveness for TPE as a bridge to transplant therapy. CAPS: Retrospective data analysis demonstrates a clear benefit in survival when a triple therapy containing anticoagulation, corticosteroids and TPE or intravenous immunoglobulin is used. However, there was no difference in survival between the usage of intravenous immunoglobulin or TPE and no added benefit in using both.Thyroid hormones can be eliminated using TPE. This has been shown in a retrospective data analysis of 2018 and caused the ASFA to view TPE as a second line therapy for thyrotoxic storm in the most recent 2019 guidelines.Die Rolle der therapeutischen Plasmapherese (TP) in der Therapie der Sepsis mit Multiorganversagen ist noch nicht abschließend geklärt (Kategorie III der American Society for Apheresis, ASFA). Zwar zeigen die verfügbaren randomisiert kontrollierten Studien (RCT) keinen eindeutigen Überlebensvorteil, prospektive Daten von 2018 belegen jedoch ein gutes Sicherheitsprofil und eine günstige Beeinflussung von Surrogatparametern auch bei hoch Katecholamin-pflichtigen Patienten im septischen Schock.Eine multizentrische RCT von 2016 konnte einen signifikanten Überlebensvorteil durch die Durchführung von „High Volume“-TP bei Patienten im akuten Leberversagen zeigen. Dies galt allerdings nur in der Subgruppe der nicht transplantierten Patienten. KATASTROPHALES ANTIPHOSPHOLIPID-ANTIKöRPER-SYNDROM (CAPS): Retrospektive Datenauswertungen von 2016 zeigten einen deutlichen Überlebensvorteil einer 3-Fachtherapie, welche die TP beinhaltet. Dies veranlasste die ASFA in ihren neuen, 2019 erschienenen Leitlinien das CAPS erstmals in die ASFA-Kategorie I einzustufen.Retrospektive Analysen von 2018 ergaben eine effektive Elimination von Schilddrüsenhormonen durch die TP. Aufgrund dessen erkennt die ASFA in ihren neuen Leitlinien die TP als Zweitlinientherapie der thyreotoxischen Krise an.

Published
2021

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