164 results on '"Hunziker L"'
Search Results
2. (829) Self-Management if Anticoagulation in Patients with Lvad, is There a Cost to Anticoagulation on Target?
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Schnegg, B., primary, Jenni, D., additional, Fürholz, M., additional, Muster, C., additional, Capek, L., additional, Lombardo, P., additional, Kopfstein, L., additional, Chavali, S., additional, Hayward, C., additional, Martinelli, M., additional, and Hunziker, L., additional
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- 2023
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3. Optimal CW-Doppler derived parameter for the diagnosis of iatrogenic mitral stenosis during transcatheter edge-to-edge repair for mitral regurgitation
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Kassar, M, primary, Madhkour, R, additional, Praz, F, additional, Hunziker, L, additional, Windecker, S, additional, and Brugger, N, additional
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- 2022
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4. Acute impact of transcatheter edge-to-edge repair for mitral regurgitation on left ventricular function
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Kassar, M, primary, Madhkour, R, additional, Praz, F, additional, Hunziker, L, additional, Windecker, S, additional, and Brugger, N, additional
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- 2022
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5. Effector identification in the pine pathogen Dothistroma septosporum
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New Zealand Plant Protection Conference and Hunziker, L.
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- 2016
6. 28-jähriger Patient mit erfolgreich behandelter dilatativer Kardiomyopathie
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Burri, E., Decker, M., Eriksson, U., Buser, P., and Hunziker, L.
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- 2008
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7. (476) From Vpra of 100% to Transplantation, Journey of the First Ocs-dbd Case in Switzerland
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Schnegg, B., Muster, C., Wieser, M., Pavlicek-Bahlo, M., Wiedermann, S., Dobner, S., Bruno, J., Capek, L., Potratz, P., Jenni, H., Sidler, D., Chanias, I., Daskalakis, M., Consiglio, J., Schwitz, F., Thomet, C., Schwerzmann, M., Immer, F., Longnus, S., Martinelli, M., Hunziker, L., Siepe, M., and Reineke, D.
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- 2023
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8. One-Year Outcomes after PCI Strategies in Cardiogenic Shock
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Thiele, H, Akin, I, Sandri, M, de Waha-Thiele, S, Meyer-Saraei, R, Fuernau, G, Eitel, I, Nordbeck, P, Geisler, T, Landmesser, U, Skurk, C, Fach, A, Jobs, A, Lapp, H, Piek, JJ, Noc, M, Goslar, T, Felix, SB, Maier, LS, Stepinska, J, Oldroyd, K, Serpytis, P, Montalescot, G, Barthelemy, O, Huber, K, Windecker, S, Hunziker, L, Savonitto, S, Torremante, P, Vrints, C, Schneider, S, Zeymer, U, Desch, S, Investigators, CULPRIT-SHOCK, Mamas, MA, Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and CULPRIT-SHOCK Investigators
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medicine.medical_specialty ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Infarction ,610 Medicine & health ,030204 cardiovascular system & hematology ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,Myocardial infarction ,cardiovascular diseases ,business.industry ,Cardiogenic shock ,R735 ,Percutaneous coronary intervention ,General Medicine ,RC666 ,medicine.disease ,R1 ,Heart failure ,Conventional PCI ,Cardiology ,Myocardial infarction complications ,Human medicine ,business ,RA ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Item does not contain fulltext BACKGROUND: Among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, the risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days was found to be lower with percutaneous coronary intervention (PCI) of the culprit lesion only than with immediate multivessel PCI. We evaluated clinical outcomes at 1 year. METHODS: We randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multivessel PCI. The results for the primary end point of death or renal-replacement therapy at 30 days have been reported previously. Prespecified secondary end points at 1 year included death from any cause, recurrent myocardial infarction, repeat revascularization, rehospitalization for congestive heart failure, the composite of death or recurrent infarction, and the composite of death, recurrent infarction, or rehospitalization for heart failure. RESULTS: As reported previously, at 30 days, the primary end point had occurred in 45.9% of the patients in the culprit-lesion-only PCI group and in 55.4% in the multivessel PCI group (P=0.01). At 1 year, death had occurred in 172 of 344 patients (50.0%) in the culprit-lesion-only PCI group and in 194 of 341 patients (56.9%) in the multivessel PCI group (relative risk, 0.88; 95% confidence interval [CI], 0.76 to 1.01). The rate of recurrent infarction was 1.7% with culprit-lesion-only PCI and 2.1% with multivessel PCI (relative risk, 0.85; 95% CI, 0.29 to 2.50), and the rate of a composite of death or recurrent infarction was 50.9% and 58.4%, respectively (relative risk, 0.87; 95% CI, 0.76 to 1.00). Repeat revascularization occurred more frequently with culprit-lesion-only PCI than with multivessel PCI (in 32.3% of the patients vs. 9.4%; relative risk, 3.44; 95% CI, 2.39 to 4.95), as did rehospitalization for heart failure (5.2% vs. 1.2%; relative risk, 4.46; 95% CI, 1.53 to 13.04). CONCLUSIONS: Among patients with acute myocardial infarction and cardiogenic shock, the risk of death or renal-replacement therapy at 30 days was lower with culprit-lesion-only PCI than with immediate multivessel PCI, and mortality did not differ significantly between the two groups at 1 year of follow-up. (Funded by the European Union Seventh Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549 .).
- Published
- 2018
9. Endocarditis due toAerococcus urinae: Diagnostic tests, fatty acid composition and killing kinetics
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Zbinden, R., Santanam, P., Hunziker, L., Leuzinger, B., and von Graevenitz, A.
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- 1999
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10. FEMTOSECOND TRANSIENT STIMULATED EMISSION PUMPING: THEORY AND EXPERIMENT
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Hunziker, L., primary, Ludowise, P., additional, Price, W., additional, Morgen, M., additional, Blackwell, M., additional, and Chen, Y., additional
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- 1995
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11. P3677Twenty-years trends in the incidence and outcome of cardiogenic shock in acute myocardial infarction in Switzerland (AMIS) Plus registry
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Hunziker, L C, primary, Radovanovic, D, additional, Jeger, R, additional, Pedrazzini, G, additional, Urban, P, additional, Erne, P, additional, Rickli, H, additional, Windecker, S, additional, and Pilgrim, T, additional
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- 2018
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12. 127Validation of high-risk features for stent-related ischaemic events as proposed by the 2017 DAPT guidelines
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Ueki, Y, primary, Zanchin, T, additional, Karagiannis, A, additional, Zanchin, C, additional, Stortecky, S, additional, Koskinas, K C, additional, Siontis, G C, additional, Praz, F, additional, Hunziker, L, additional, Heg, D, additional, Billinger, M, additional, Valgimigli, M, additional, Pilgrim, T, additional, Windecker, S, additional, and Raber, L, additional
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- 2018
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13. P3651In-vivo correlation of near-infrared spectroscopy lipid content and optical coherence tomography minimal cap thickness
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Zanchin, C, primary, Ueki, Y, additional, Haener, J, additional, Zanchin, T, additional, Hunziker, L, additional, Stortecky, S, additional, Spirk, D, additional, Koskinas, K C, additional, Karagiannis, A, additional, Windecker, S, additional, and Raeber, L, additional
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- 2018
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14. 4179Cardiovascular outcomes following percutaneous coronary intervention among patients with cancer: observations from a large unselected cohort
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Ueki, Y, primary, Voegeli, B, additional, Karagiannis, A, additional, Zanchin, T, additional, Zanchin, C, additional, Stortecky, S, additional, Koskinas, K C, additional, Moro, C, additional, Moschovitis, A, additional, Hunziker, L, additional, Valgimigli, M, additional, Pilgrim, T, additional, Suter, T, additional, Windecker, S, additional, and Raber, L, additional
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- 2018
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15. Maintenance of memory CTL responses by T helper cells and CD40-CD40 ligand: antibodies provide the key (vol 34, pg 317, 2004)
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Bachmann, MF, Hunziker, L, Zinkernagel, RM, Storni, T, and Kopf, M
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- 2016
16. 5704Validation of the SCAI definition of periprocedural myocardial infarction for prediction of one-year mortality following elective percutaneous coronary interventions
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Koskinas, K.C., primary, Ndrepepa, G., additional, Raeber, L., additional, Kufner, S., additional, Karagiannis, A., additional, Zanchin, T., additional, Hieber, J., additional, Hunziker, L., additional, Byrne, R.A., additional, Heg, D., additional, Windecker, S., additional, and Kastrati, A., additional
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- 2017
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17. Femtosecond transient stimulated emission pumping studies of ozone visible photodissociation.
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Chen, Y., Hunziker, L., Ludowise, P., and Morgen, M.
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SPECTRUM analysis , *OZONE , *PHOTODISSOCIATION - Abstract
We report a new variant of the femtosecond transition-state spectroscopy technique-transient stimulated emission pumping (TSEP). The initial application of TSEP to studies of ozone visible photodissociation indicates that the molecule is trapped in the Franck–Condon region for ∼90 fs. The wave packet then spreads along the reaction coordinate. [ABSTRACT FROM AUTHOR]
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- 1992
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18. Interferon-gamma regulates idiopathic pneumonia syndrome, a Th17+CD4+ T-cell-mediated graft-versus-host disease
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Mauermann, N, Burian, J, von Garnier, C, Dirnhofer, S, Germano, D, Schuette, C, Tamm, M, Bingisser, R, Eriksson, U, Hunziker, L, University of Zurich, and Hunziker, L
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2740 Pulmonary and Respiratory Medicine ,10209 Clinic for Cardiology ,610 Medicine & health ,2706 Critical Care and Intensive Care Medicine - Published
- 2008
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19. Effector identification in the pine pathogen Dothistroma septosporum
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Hunziker, L., primary, Mesarich, C.H., additional, McDougal, R.L., additional, and Bradshaw, R.E., additional
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- 2016
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20. Lie group symmetries of delay and integro differential equations
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Hunziker, L
- Abstract
University of Technology, Sydney. Faculty of Engineering and Information Technology. NO FULL TEXT AVAILABLE. Access is restricted indefinitely. The hardcopy may be available for consultation at the UTS Library. NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- In this thesis we extend the classical algorithm for computing point symmetries of differential equations to delay- and integro differential equations of several variables. Similar efforts have been made in the past but never with a rigorous geometrical framework. We will close this gap. Our approach provides a tool to solve or reduce a large class of equations including recursive relations, delay differential equations, integro partial differential equations, discretised differential equations and initial value problems. We introduce a structure on a bundle, which allows us to define a coordinate system on the bundle suitable to represent the values of a function on different values in its domain. This structure is again a bundle, similar to the jet bundle used to represent differential equations as embedded submanifolds via derivative coordinates. The proof is a straight forward consequence of the classical results and is given in the first part of this thesis. This allows us to use all classical theorems regarding invariance of sets under (one-parameter) group actions. We show how to prolong group actions and their generators to the introduced bundle. In this setup it is possible to represent delay-, respectively functional equations as level sets and we are able to compute symmetries, i.e. actions leaving the space of solutions invariant. It turns out that already very simple examples of such equations have non-trivial symmetries, which can be computed in a straight forward manner. The symmetries allow us to solve equations via symmetry reduction or to construct non-trivial solutions from simple known solutions. We give various examples of this. We can apply a similar strategy to delay differential equations by adapting the notion of derivative coordinates to our set-up. The geometrical setting must only be altered slightly to achieve this. We compute various examples, where we solve delay differential equations in one and two unknowns via its group of symmetries. The extension to integral- and integro differential equations is done via replacing integrals with corresponding Riemann sums. This only requires expressing the values of an unknown function on a partition of the area of integration as coordinates on a bundle. The introduced coordinate system turns out to be capable of this. We combine this again with derivative coordinates and illustrate how to compute symmetries of such equations. We compute analytical solutions of integro partial differential equations. In all of the above we face the problem that the domain of definition cannot be chosen to be an arbitrary small (open) set in the domain of an unknown function, as in the case of differential equations. The non-local nature of the equations must be taken into account. We solve this problem by making a priori assumptions on the regularity of the transformed functions, respectively the group actions. Strictly speaking we are computing conditional symmetries. However, in most practical situations the restriction is unnecessary. This thesis is structured as follows. The first chapter consists of an introduction where we present an overview of the classical theory of symmetries of differential equations. We conclude the chapter with a summary of five methods developed by other authors to compute symmetries of integro differential equations. We point out some problems and flaws in those theories. The second chapter consists of the main body of work, i.e. our main results. We introduce the space Dπ which will be the foundation for all of our reasoning. The space is endowed with a bundle structure and we show how one-parameter group actions induce morphisms on Dπ. We then continue explaining how different types of equations - of increasing complexity - can be represented as level sets of real-valued functions and how the main idea, i.e. symmetries being transformations leaving the solution space invariant, can be expressed in terms of bundle morphisms. This climaxes in theorem 2.18, describing an algorithm for finding the symmetry groups of integro partial differential equations for functions of any number of variables and arbitrary domains of integration. In every section we compute numerous examples of symmetry groups of the various types of equations under consideration. In the third chapter we apply the same techniques to some major applications. They include transition and boundary-crossing probabilities of jump diffusions, initial value problems, discretised partial differential equations and the Vlasov-Maxwell equations. I would like to express my gratitude to Dr. Mark Craddock for his guidance over the past four years.
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- 2012
21. Prominin-1/CD133+ lung epithelial progenitors protect from bleomycin-induced pulmonary fibrosis
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Germano, D, Blyszczuk, P, Valaperti, A, Kania, G, Dirnhofer, S, Landmesser, U, Lüscher, T F, Hunziker, L, Zulewski, H, Eriksson, U, University of Zurich, and Germano, D
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2740 Pulmonary and Respiratory Medicine ,10076 Center for Integrative Human Physiology ,10209 Clinic for Cardiology ,570 Life sciences ,biology ,610 Medicine & health ,2706 Critical Care and Intensive Care Medicine ,10052 Institute of Physiology - Published
- 2009
22. Heart-infiltrating prominin-1+/CD133+ progenitor cells represent the cellular source of transforming growth factor beta-mediated cardiac fibrosis in experimental autoimmune myocarditis
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Kania, G, Blyszczuk, P, Stein, S, Valaperti, A, Germano, D, Dirnhofer, S, Hunziker, L, Matter, C M, Eriksson, U, University of Zurich, and Kania, G
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10076 Center for Integrative Human Physiology ,10209 Clinic for Cardiology ,570 Life sciences ,biology ,610 Medicine & health ,1314 Physiology ,2705 Cardiology and Cardiovascular Medicine ,10052 Institute of Physiology - Published
- 2009
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23. Prospective Comparison of Noninvasive, Bedside Ultrasound Methods for Assessing Central Venous Pressure
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Uthoff, H., additional, Siegemund, M., additional, Aschwanden, M., additional, Hunziker, L., additional, Fabbro, T., additional, Baumann, U., additional, Jaeger, K., additional, Imfeld, S., additional, and Staub, D., additional
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- 2012
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24. Increased Coexpression of Eotaxin and Interleukin 5 in Bullous Pemphigoid
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Shrikhande, T. Hunziker, L. R. Braa, M., primary
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- 2000
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25. Femtosecond Raman-induced polarization spectroscopy studies of rotational coherence in O2, N2 and CO2
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Morgen, M., primary, Price, W., additional, Hunziker, L., additional, Ludowise, P., additional, Blackwell, M., additional, and Chen, Y., additional
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- 1993
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26. Prominin-1/CD133+ lung epithelial progenitors protect from bleomycin-induced pulmonary fibrosis.
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Germano D, Blyszczuk P, Valaperti A, Kania G, Dirnhofer S, Landmesser U, Lüscher TF, Hunziker L, Zulewski H, Eriksson U, Germano, Davide, Blyszczuk, Przemyslaw, Valaperti, Alan, Kania, Gabriela, Dirnhofer, Stephan, Landmesser, Ulf, Lüscher, Thomas F, Hunziker, Lukas, Zulewski, Henryk, and Eriksson, Urs
- Abstract
Rationale: The mouse model of bleomycin-induced lung injury offers an approach to study idiopathic pulmonary fibrosis, a progressive interstitial lung disease with poor prognosis. Progenitor cell-based treatment strategies might combine antiinflammatory effects and the capacity for tissue repair.Objectives: To expand progenitor cells with reparative and regenerative capacities and to evaluate their protective effects on pulmonary fibrosis in vivo.Methods: Prominin-1/CD133(+) epithelial progenitor cells (PEPs) were expanded from adult mouse lungs after digestion and culture of distal airways. Lung fibrosis was induced in C57Bl/6 mice by instillation of bleomycin. Two hours later, animals were transplanted with PEPs. Inflammation and fibrosis were assessed by immunohistochemistry, bronchoalveolar lavage fluid differentials, and real-time polymerase chain reaction.Measurements and Main Results: PEPs expanded from mouse lungs were of bone marrow origin, coexpressed stem and hematopoietic cell markers, and differentiated in vitro into alveolar type II surfactant protein-C(+) epithelial cells. In bleomycin-challenged mice, intratracheally injected PEPs engrafted into the lungs and differentiated into type II pneumocytes. Furthermore, PEPs suppressed proinflammatory and profibrotic gene expression, prevented the recruitment of inflammatory cells, and protected bleomycin-challenged mice from pulmonary fibrosis. Mechanistically, the protective effect depended on upregulation of inducible nitric oxide synthase in PEPs and nitric oxide-mediated suppression of alveolar macrophage proliferation. Accordingly, PEPs from iNOS(-/-) but not iNOS(+/+) mice failed to protect from bleomycin-induced lung injury.Conclusions: The combined antiinflammatory and regenerative capacity of bone marrow-derived pulmonary epithelial progenitors offers a promising approach for development of cell-based therapeutic strategies against pulmonary fibrosis. [ABSTRACT FROM AUTHOR]- Published
- 2009
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27. MyD88 signaling controls autoimmune myocarditis induction.
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Marty RR, Dirnhofer S, Mauermann N, Schweikert S, Akira S, Hunziker L, Penninger JM, and Eriksson U
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- 2006
28. IgA responses in the intestinal mucosa against pathogenic and non-pathogenic microorganisms
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Macpherson, A. J., Hunziker, L., McCoy, K., and Lamarre, A.
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- 2001
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29. Neutralizing antiviral antibodies reduce hematogenic viral spread but not antiviral cytotoxic T cell induction and subsequent immunopathology.
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Battegay, M, Seiler, P, Hunziker, L, Wolf, K, and Zinkernagel, R M
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THERAPEUTIC use of monoclonal antibodies ,ANIMALS ,BIOLOGICAL models ,IMMUNIZATION ,MICE ,RNA viruses ,T cells ,VIRAL antibodies ,VIRAL meningitis ,THERAPEUTICS - Published
- 2001
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30. Endocarditis due to Aerococcus urinae: Diagnostic tests, fatty acid composition and killing kinetics.
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Zbinden, R., Santanam, P., Hunziker, L., Leuzinger, B., and Graevenitz, A.
- Abstract
Two cases of Aerococcus urinae endocarditis are reported. The organism is not included in any database of commercial identification systems at this time. Formation of tetrades and positive reactions for leucine arylamidase and beta-glucuronidase pointed strongly to A. urinae. The cellular fatty acid pattern was similar to that of Aerococcus viridans, with predominantly C
16∶0 , C18∶1ω9c and C18∶0 ; the presence of C18∶1ω7t differentiated our isolates from A. viridans and can support the diagnosis of A. urinae. Furthermore, susceptibility to penicillin but resistance to cotrimoxazole represents a pattern opposite to that of A. viridans. Minimal inhibition concentrations of gentamicin and netilmicin were≤64 mg/l but those of tobramycin were≥256 mg/l. Penicillin combined with either gentamicin or netilmicin showed distinct synergy in killing kinetics. These combinations seem to be the appropriate regimen to treat A. urinae endocarditis. [ABSTRACT FROM AUTHOR]- Published
- 1999
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31. Deliberate removal of T cell help improves virus-neutralizing antibody production
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Recher, M., Lang, K. S., Hunziker, L., Freigang, S., Eschli, B., Harris, N. L., Navarini, A., Senn, B. M., Fink, K., Lotscher, M., Hangartner, L., Zellweger, R., Hersberger, M., Theocharides, A., Hengartner, H., and Zinkernagel, R. M.
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B-Lymphocytes/*immunology ,Mice ,CD4-Positive T-Lymphocytes/*immunology ,Lymphocyte Activation/*immunology ,Animals ,Enzyme-Linked Immunosorbent Assay ,Lymphocytic choriomeningitis virus/immunology ,Antibody Formation/*immunology ,Flow Cytometry ,Arenaviridae Infections/immunology - Abstract
The B cell response to lymphocytic choriomeningitis virus is characterized by a CD4(+) T cell-dependent polyclonal hypergammaglobulinemia and delayed formation of virus-specific neutralizing antibodies. Here we provide evidence that, paradoxically, because of polyclonal B cell activation, virus-specific T cell help impairs the induction of neutralizing antibody responses. Experimental reduction in CD4(+) T cell help in vivo resulted in potent neutralizing antibody responses without impairment of CD8(+) T cell activity. These unexpected consequences of polyclonal B cell activation may affect vaccine strategies and the treatment of clinically relevant chronic bacterial, parasitic and viral infections in which hypergammaglobulinemia is regularly found.
32. Circulating levels of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in community-acquired pneumonia.
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Müller B, Gencay MM, Gibot S, Cedex N, Stolz D, Hunziker L, Tamm M, Christ-Crain M, Müller, Beat, Gencay, Mikael M, Gibot, Sebastien, Stolz, Daiana, Hunziker, Lukas, Tamm, Michael, and Christ-Crain, Mirjam
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- 2007
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33. Self-Management if Anticoagulation in Patients with Lvad, is There a Cost to Anticoagulation on Target?
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Schnegg, B., Jenni, D., Fürholz, M., Muster, C., Capek, L., Lombardo, P., Kopfstein, L., Chavali, S., Hayward, C., Martinelli, M., and Hunziker, L.
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PATIENT self-monitoring , *HEART assist devices , *COVID-19 pandemic , *COST control , *ANTICOAGULANTS , *PRICES - Abstract
Following the wave of COVID and the numerous protocols of INR -self-management for patients with LVAD, it has been demonstrated that patients can monitor and adjust their anticoagulation and achieve better time in therapeutic range (TTR) compared to standard monitoring and care by physicians. To achieve this goal, more INR tests are performed. Here we compare the TTR in self-management versus the standard treatment and the costs of these two strategies in a European context. Using a protocol established at St-Vincent Hospital in Australia, patients were offered to follow a training on anticoagulation and then manage their anti-vitamin K treatment independently (Auto-management). We then compared the TTR and the cost before and under this protocol. Costs are based on Swiss prices and converted into Dollars (1CHF=1.03US $). Test-strip cost $4.8 per unit, the lancet costs a few cents, and the INR machine (CoaguCheck) is available for $810. The combined cost of the blood test and its interpretation by a general physician (GP) is about $50. Since November 2021, 11 patients have been included in the protocol; these included no women, one patient with a HeartWare, and 10 with a HeartMate 3. The patients have been included in the protocol for a cumulative time of 80 months or a mean of 7.3 months per patient. One patient was transplanted, and none died. One patient had a haemorrhagic complication following colonoscopy under therapeutic INR (2.8), no patient suffered thrombosis, and no LVAD replacement was performed. We compare this group during the Standard Care (SC) and Auto-management (AM) period. During SC, the median TTR was 72% (IQR 63-78); during AM it increased to 90% (IQR 77-93). In SC, the INR control cost per day was $9.4 (IQR 6.6-13) on average, which decreased to $2.4 (IQR 1.9-2.6) per day in AM. INR monitoring occurred on average 5.9 (IQR 4.2-8.2) times per month in SC phase; while in AM patients measured their INR 13.1 (IQR 11.7-13.4) times per month. The cost of one day of INR within the therapeutic range was $13 under standard care, $5.0 in the first year on Auto-management. Despite being associated with more INR control, Self-management of anticoagulation by LVAD- patients are less expensive and results in a higher TTR. Self-management also promotes patient independence. It should be encouraged and expanded to other LVAD implant centres. [ABSTRACT FROM AUTHOR]
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- 2023
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34. Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest
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Alessandro Spirito, Lukas Vaisnora, Athanasios Papadis, Fortunato Iacovelli, Celestino Sardu, Alexandra Selberg, Sarah Bär, Raminta Kavaliauskaite, Fabrice Temperli, Babken Asatryan, Thomas Pilgrim, Lukas Hunziker, Dik Heg, Marco Valgimigli, Stephan Windecker, Lorenz Räber, Spirito, A., Vaisnora, L., Papadis, A., Iacovelli, F., Sardu, C., Selberg, A., Bar, S., Kavaliauskaite, R., Temperli, F., Asatryan, B., Pilgrim, T., Hunziker, L., Heg, D., Valgimigli, M., Windecker, S., and Raber, L.
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death ,non–ST-segment elevation ,coronary angiography ,out-of-hospital cardiac arrest ,Cardiology and Cardiovascular Medicine ,610 Medizin und Gesundheit ,coronary occlusion - Abstract
Background: According to current guidelines, hemodynamic status should guide the decision between immediate and delayed coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation. A delayed strategy is advised in hemodynamically stable patients, and an immediate approach is recommended in unstable patients. Objectives: This study sought to assess the frequency, predictors, and clinical impact of acute coronary occlusion in hemodynamically stable and unstable OHCA patients without ST-segment elevation. Methods: Consecutive unconscious OHCA patients without ST-segment elevation who were undergoing CAG at Bern University Hospital (Bern, Switzerland) between 2011 and 2019 were included. Frequency and predictors of acute coronary artery occlusions and their impact on all-cause and cardiovascular mortality at 1 year were assessed. Results: Among the 386 patients, 169 (43.8%) were hemodynamically stable. Acute coronary occlusions were found in 19.5% of stable and 24.0% of unstable OHCA patients (P=0.407), and the presence of these occlusions was predicted by initial chest pain and shockable rhythm, but not by hemodynamic status. Acute coronary occlusion was associated with an increased risk of cardiovascular death (adjusted HR: 2.74; 95%CI: 1.22-6.15) but not of all-cause death (adjusted HR:0.72; 95%CI: 0.44-1.18). Hemodynamic instability was not predictive of fatal outcomes. Conclusions: Acute coronary artery occlusions were found in 1 in 5 OHCA patients without ST-segment elevation.The frequency of these occlusions did not differ between stable and unstable patients, and the occlusions wereassociated with a higher risk of cardiovascular death. In OHCA patients without ST-segment elevation, chest painorshockable rhythm rather than hemodynamic status identifies patients with acute coronary occlusion.
- Published
- 2023
35. Validation of the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria in patients undergoing percutaneous coronary intervention and comparison with contemporary bleeding risk scores
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Fabien Praz, Thomas Pilgrim, Christian Zanchin, Jonas Lanz, Felice Gragnano, Giuseppe Gargiulo, Marco Valgimigli, Thomas Zanchin, Sylvain Losdat, Sarah Bär, Stephan Windecker, Tatsuhiko Otsuka, Lukas Hunziker, Stefan Stortecky, George C.M. Siontis, Lorenz Räber, Dik Heg, Yasushi Ueki, University of Zurich, Ueki, Y., Bar, S., Losdat, S., Otsuka, T., Zanchin, C., Zanchin, T., Gragnano, F., Gargiulo, G., Siontis, G. C. M., Praz, F., Lanz, J., Hunziker, L., Stortecky, S., Pilgrim, T., Heg, D., Valgimigli, M., Windecker, S., and Raber, L.
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Target lesion ,stable angina ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Hemorrhage ,610 Medicine & health ,030204 cardiovascular system & hematology ,11171 Cardiocentro Ticino ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,AIDS-Related Complex ,Risk Factors ,Internal medicine ,Clinical endpoint ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Myocardial infarction ,Framingham Risk Score ,ACS/NSTE-ACS ,business.industry ,Platelet Aggregation Inhibitor ,Risk Factor ,Percutaneous coronary intervention ,bleeding ,medicine.disease ,Conventional PCI ,Platelet aggregation inhibitor ,Cardiology and Cardiovascular Medicine ,business ,coronary artery disease ,Platelet Aggregation Inhibitors ,Human - Abstract
AIMS The Academic Research Consortium for High Bleeding Risk (ARC-HBR) defined consensus-based criteria for patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI). We aimed to validate the ARC-HBR criteria for the bleeding outcomes using a large cohort of patients undergoing PCI. METHODS AND RESULTS Between 2009 and 2016, patients undergoing PCI were prospectively included in the Bern PCI Registry. Patients were considered to be at HBR if at least one major criterion or two minor criteria were met. The primary endpoint was Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding at one year; ischaemic outcomes were assessed using the device-oriented composite endpoints (DOCE) of cardiac death, target vessel myocardial infarction, and target lesion revascularisation. Among 12,121 patients, those at HBR (n=4,781, 39.4%) had an increased risk of BARC 3 or 5 bleeding (6.4% vs 1.9%; p
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- 2020
36. Cangrelor, Tirofiban, and Chewed or Standard Prasugrel Regimens in Patients With ST-Segment-Elevation Myocardial Infarction: Primary Results of the FABOLUS-FASTER Trial
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Pascal Vranckx, Marisa Avvedimento, Plinio Cirillo, Pietro Minuz, Dik Heg, Giovanni Esposito, Felice Gragnano, Sergio Leonardi, Marco Valgimigli, Negar Manavifar, Raffaele Piccolo, Michael Nagler, Giuseppe Gargiulo, Gianluca Campo, Stephan Windecker, Lukas Hunziker, Matteo Tebaldi, Gargiulo, G., Esposito, G., Avvedimento, M., Nagler, M., Minuz, P., Campo, G., Gragnano, F., Manavifar, N., Piccolo, R., Tebaldi, M., Cirillo, P., Hunziker, L., Vranckx, P., Leonardi, S., Heg, D., Windecker, S., Valgimigli, M., University of Zurich, and Valgimigli, Marco
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Male ,Cardiac Catheterization ,Prasugrel ,Platelet Aggregation ,Administration, Oral ,Comorbidity ,chemistry.chemical_compound ,2737 Physiology (medical) ,P2Y12 ,ST segment ,Myocardial infarction ,Infusions, Intravenous ,610 Medicine & health ,Aged, 80 and over ,Heart ,Tirofiban ,Middle Aged ,Adenosine Diphosphate ,Treatment Outcome ,Area Under Curve ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Ticagrelor ,medicine.drug ,Tablets ,medicine.medical_specialty ,11171 Cardiocentro Ticino ,2705 Cardiology and Cardiovascular Medicine ,NO ,Cangrelor ,Percutaneous Coronary Intervention ,Physiology (medical) ,Internal medicine ,cangrelor, percutaneous coronary intervention, platelet aggregation, prasugrel hydrochloride, tirofiban ,medicine ,Humans ,Aged ,Proportional Hazards Models ,Prasugrel Hydrochloride ,Aspirin ,business.industry ,medicine.disease ,Adenosine Monophosphate ,chemistry ,Polypharmacy ,Purinergic P2Y Receptor Antagonists ,Mastication ,ST Elevation Myocardial Infarction ,business ,cangrelor - Abstract
Background: Standard administration of newer oral P2Y 12 inhibitors, including prasugrel or ticagrelor, provides suboptimal early inhibition of platelet aggregation (IPA) in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention. We aimed to investigate the effects of cangrelor, tirofiban, and prasugrel, administered as chewed or integral loading dose, on IPA in patients undergoing primary percutaneous coronary intervention. Methods: The FABOLUS-FASTER trial (Facilitation Through Aggrastat or Cangrelor Bolus and Infusion Over Prasugrel: A Multicenter Randomized Open-Label Trial in Patients with ST-Elevation Myocardial Infarction Referred for Primary Percutaneous Intervention) is an investigator-initiated, multicenter, open-label, randomized study. A total of 122 P2Y 12 -naive patients with ST-segment–elevation myocardial infarction were randomly allocated (1:1:1) to cangrelor (n=40), tirofiban (n=40) (both administered as bolus and 2-hour infusion followed by 60 mg of prasugrel), or 60-mg loading dose of prasugrel (n=42). The latter group underwent an immediate 1:1 subrandomization to chewed (n=21) or integral (n=21) tablets administration. The trial was powered to test 3 hypotheses (noninferiority of cangrelor compared with tirofiban using a noninferiority margin of 9%, superiority of both tirofiban and cangrelor compared with chewed prasugrel, and superiority of chewed prasugrel as compared with integral prasugrel, each with α=0.016 for the primary end point, which was 30-minute IPA at light transmittance aggregometry in response to 20 μmol/L adenosine diphosphate. Results: At 30 minutes, cangrelor did not satisfy noninferiority compared with tirofiban, which yielded superior IPA over cangrelor (95.0±8.9 versus 34.1±22.5; P P P =0.47), despite yielding higher prasugrel active metabolite concentration (ng/mL; 62.3±82.6 versus 17.1±43.5; P =0.016). Conclusions: Cangrelor provided inferior IPA compared with tirofiban; both treatments yielded greater IPA compared with chewed prasugrel, which led to higher active metabolite concentration but not greater IPA compared with integral prasugrel. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02978040; URL: https://www.clinicaltrialsregister.eu ; EudraCT 2017-001065-24.
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- 2020
37. Validation of high bleeding risk criteria and definition as proposed by the academic research consortium for high bleeding risk
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Jonas Lanz, Thomas Pilgrim, Davide Capodanno, Thomas Zanchin, Stephan Windecker, Christian Zanchin, Fabien Praz, Lukas Hunziker, Dik Heg, Felice Gragnano, Stefan Stortecky, Marco Valgimigli, Philip Urban, George C.M. Siontis, Stuart J. Pocock, Roberto Galea, Lukas Vaisnora, Lorenz Räber, Giuseppe Gargiulo, Noé Corpataux, Alessandro Spirito, Stefano Svab, University of Zurich, Corpataux, N., Spirito, A., Gragnano, F., Vaisnora, L., Galea, R., Svab, S., Gargiulo, G., Zanchin, T., Zanchin, C., Siontis, G. C. M., Praz, F., Lanz, J., Hunziker, L., Stortecky, S., Pilgrim, T., Raber, L., Capodanno, D., Urban, P., Pocock, S., Heg, D., Windecker, S., and Valgimigli, M.
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medicine.medical_specialty ,Academic Research Consortium ,medicine.medical_treatment ,Hemorrhage ,610 Medicine & health ,Minor (academic) ,030204 cardiovascular system & hematology ,11171 Cardiocentro Ticino ,2705 Cardiology and Cardiovascular Medicine ,Percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Validation ,Humans ,Medicine ,030212 general & internal medicine ,Risk criteria ,Oral anticoagulation ,Retrospective Studies ,business.industry ,Bleeding ,University hospital ,Confidence interval ,Conventional PCI ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
Aims To validate the set of clinical and biochemical criteria proposed by consensus by the Academic Research Consortium (ARC) for High Bleeding Risk (HBR) for the identification of HBR patients. These criteria were categorized into major and minor, if expected to carry in isolation, respectively, ≥4% and Methods and results All patients undergoing PCI at Bern University Hospital, between February 2009 and September 2018 were prospectively entered into the Bern PCI Registry (NCT02241291). Age, haemoglobin, platelet count, creatinine, and use of oral anticoagulation were prospectively collected, while the remaining HBR criteria except for planned surgery were retrospectively adjudicated. A total of 16 580 participants with complete ARC-HBR criteria were included. After assigning 1 point to each major and 0.5 point to each minor criterion, we observed for every 0.5 score increase a step-wise augmentation of BARC 3 or 5 bleeding rates at 1 year ranging from 1.90% among patients fulfilling no criterion, through 4.01%, 5.98%, 7.42%, 8.60%, 12.21%, 12.29%, and 17.64%. All major and five out of six minor criteria, conferred in isolation a risk for BARC 3 or 5 bleeding at 1 year exceeding 4% at the upper limit of the 95% confidence intervals. Conclusion All major and the majority of minor ARC-HBR criteria identify in isolation patients at HBR.
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- 2020
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38. Effect of Timely Availability of TTR-Stabilizing Therapy on Diagnosis, Therapy, and Clinical Outcomes in ATTR-CM.
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Dobner S, Zarro S, Wieser F, Kassar M, Alaour B, Wiedemann S, Bakula A, Caobelli F, Stortecky S, Gräni C, Hunziker L, and Bernhard B
- Abstract
Background : Tafamidis reduces cardiovascular morbidity and mortality in transthyretin amyloid cardiomyopathy (ATTR-CM), yet availability and access to therapy vary. Objective : To determine how availability and access to tafamidis impact time-to-diagnosis, time-to-therapy, and cardiovascular outcomes in ATTR-CM. Methods : Ninety-one consecutive ATTR-CM (~97% wt-TTR) patients diagnosed between June 2019 and June 2021 were evaluated for tafamidis. Access to therapy was regulated by compassionate use [n(CU) = 42] prior to, and insurance [n(IA) = 49] after regulatory approval. Results : Tafamidis was started in 37/42 (88.1%), and 39/49 (79.6%) patients, respectively. At diagnosis, ATTR-CM disease stage (≤stage 2: 88.2% vs. 90.9%, p = 0.92) was similar between groups. Timely access (after tafamidis approval) reduced the median time from first presentation to diagnosis from 6.2 (IQR: 1.3-28.9) to 2.4 (0.7-21.7) months, and from first presentation to therapy from 24.4 (10.7-46.8) to 11.8 (6.4-32.4) months. While RV function significantly worsened between diagnosis and therapy initiation in CU patients diagnosed before tafamidis approval (S'-velocity 10.0 ± 2.2 to 9.2 ± 2.2 cm/s; p = 0.018; TAPSE 17.3 ± 4.7 to 15.7 ± 3.9 mm, p = 0.008), it remained unchanged in IA patients (S'-velocity 9.6 ± 2.6 to 9.4 ± 2.3 cm/s; p = 0.83; TAPSE 15.6 ± 4.2 to 16.3 ± 3.1 mm, p = 0.45). After a median follow-up of 42.3 and 24.9 months in CU and IA patients, respectively, timely availability was associated with a reduction in annual heart failure hospitalizations (0.40 vs. 0.16 per patient, p < 0.001) and improved MACE-free survival (HR = 0.51; 95%CI: 0.26-1.00; p = 0.051). Timely diagnosis (<12-months) prolonged MACE-free survival (HR = 0.424; 95%CI: 0.22-0.81; p = 0.004), and reduced HFH (HR = 0.40; 95%CI: 0.19-0.81); p = 0.011) and all-cause mortality (HR = 0.29; 95%CI: 0.11-0.74); p = 0.009). Conclusions : Availability of tafamidis improves diagnostic efficacy in ATTR-CM patients. Timely diagnosis and initiation of therapy reduces adverse cardiovascular events.
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- 2024
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39. Association between caseload volume and outcomes in left ventricular assist device implantations - a EUROMACS analysis.
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Mihalj M, Reineke D, Just IA, Mulzer J, Cholevas N, Hoermandinger C, Veen K, Luedi MM, Heinisch PP, Potapov E, Gummert JF, Mohacsi P, Hagl C, Faerber G, Zimpfer D, de By TMMH, Meyns B, Gustafsson F, Hunziker L, Siepe M, Schober P, and Schoenrath F
- Abstract
Aims: This EUROMACS study was conducted with the primary aim of investigating the association between a centre's annual caseload and postoperative outcomes among patients undergoing left ventricular assist device (LVAD) implantation., Methods and Results: A total of 4802 patients identified between 2011 and 2020 from 35 participating centres were dichotomized based on the annual caseload of the treating centre at the time of device implant (≤30 vs. >30 LVAD implantations/year). The primary endpoint was 1-year survival. Secondary outcomes included overall survival analysis, device-related adverse events and readmissions. Cumulative follow-up was 10 003 patient-years, with a median follow-up of 1.54 years (interquartile range 0.52-3.15). Patients from higher volume centres more frequently presented in INTERMACS levels 1 and 2, suffered from right heart dysfunction and needed inotropic support. No difference was observed in adjusted 1-year survival. Adjusted overall survival probability was lower in higher volume centres (p = 0.002). In the subgroup analysis of HeartMate 3 devices only, higher volume centres were associated with decreased odds of 1-year survival (adjusted odds ratio 0.43, 95% confidence interval 0.20-0.97, p = 0.041). Similar findings were observed in the cumulative (i.e. learning curve) caseload analyses., Conclusion: In patients undergoing LVAD implantation, centre volume was not associated with 1-year survival, but was related to device-related adverse events. Patient profiles differed with respect to centre size. These findings underscore the necessity for ongoing quality improvement initiatives in all centres, regardless of their annual caseload. Efforts are needed to standardize patient selection and preconditioning to further improve patient outcome., (© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2024
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40. Impact of tafamidis on myocardial function and CMR tissue characteristics in transthyretin amyloid cardiomyopathy.
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Dobner S, Bernhard B, Ninck L, Wieser M, Bakula A, Wahl A, Köchli V, Spano G, Boscolo Berto M, Elchinova E, Safarkhanlo Y, Stortecky S, Schütze J, Shiri I, Hunziker L, and Gräni C
- Abstract
Aims: Tafamidis improves clinical outcomes in transthyretin amyloid cardiomyopathy (ATTR-CM), yet how tafamidis affects cardiac structure and function remains poorly described. This study prospectively analysed the effect of tafamidis on 12-month longitudinal changes in cardiac structure and function by cardiac magnetic resonance (CMR) compared with the natural course of disease in an untreated historic control cohort., Methods and Results: ATTR-CM patients underwent CMR at tafamidis initiation and at 12 months. Untreated patients with serial CMRs served as reference to compare biventricular function, global longitudinal strain (GLS), LV mass and extracellular volume fraction (ECV). Thirty-six tafamidis-treated (n = 35; 97.1% male) and 15 untreated patients (n = 14; 93.3% male) with a mean age of 78.3 ± 6.5 and 76.9 ± 6.5, respectively, and comparable baseline characteristics were included. Tafamidis was associated with preserving biventricular function (LVEF (%): 50.5 ± 12 to 50.7 ± 11.5, P = 0.87; RVEF (%): 48.2 ± 10.4 to 48.2 ± 9.4, P = 0.99) and LV-GLS (-9.6 ± 3.2 to -9.9 ± 2.4%; P = 0.595) at 12 months, while a significantly reduced RV-function (50.8 ± 7.3 to 44.2 ± 11.6%, P = 0.028; P (change over time between groups) = 0.032) and numerically worsening LVGLS (-10.9 ± 3.3 to -9.1 ± 2.9%, P = 0.097; P (change over time between groups) = 0.048) was observed without treatment. LV mass significantly declined with tafamidis (184.7 ± 47.7 to 176.5 ± 44.3 g; P = 0.011), yet remained unchanged in untreated patients (163.8 ± 47.5 to 171.2 ± 39.7 g P = 0.356, P (change over time between groups) = 0.027). Irrespective of tafamidis, ECV and native T1-mapping did not change significantly from baseline to 12-month follow-up (P > 0.05)., Conclusions: Compared with untreated ATTR-CM patients, initiation of tafamidis preserved CMR-measured biventricular function and reduced LV mass at 12 months. ECV and native T1-mapping did not change significantly comparable to baseline in both groups., (© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2024
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41. Mechanisms maintaining right ventricular contractility-to-pulmonary arterial elastance ratio in VA ECMO: a retrospective animal data analysis of RV-PA coupling.
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Bachmann KF, Moller PW, Hunziker L, Maggiorini M, and Berger D
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Background: To optimize right ventricular-pulmonary coupling during veno-arterial (VA) ECMO weaning, inotropes, vasopressors and/or vasodilators are used to change right ventricular (RV) function (contractility) and pulmonary artery (PA) elastance (afterload). RV-PA coupling is the ratio between right ventricular contractility and pulmonary vascular elastance and as such, is a measure of optimized crosstalk between ventricle and vasculature. Little is known about the physiology of RV-PA coupling during VA ECMO. This study describes adaptive mechanisms for maintaining RV-PA coupling resulting from changing pre- and afterload conditions in VA ECMO., Methods: In 13 pigs, extracorporeal flow was reduced from 4 to 1 L/min at baseline and increased afterload (pulmonary embolism and hypoxic vasoconstriction). Pressure and flow signals estimated right ventricular end-systolic elastance and pulmonary arterial elastance. Linear mixed-effect models estimated the association between conditions and elastance., Results: At no extracorporeal flow, end-systolic elastance increased from 0.83 [0.66 to 1.00] mmHg/mL at baseline by 0.44 [0.29 to 0.59] mmHg/mL with pulmonary embolism and by 1.36 [1.21 to 1.51] mmHg/mL with hypoxic pulmonary vasoconstriction (p < 0.001). Pulmonary arterial elastance increased from 0.39 [0.30 to 0.49] mmHg/mL at baseline by 0.36 [0.27 to 0.44] mmHg/mL with pulmonary embolism and by 0.75 [0.67 to 0.84] mmHg/mL with hypoxic pulmonary vasoconstriction (p < 0.001). Coupling remained unchanged (2.1 [1.8 to 2.3] mmHg/mL at baseline; - 0.1 [- 0.3 to 0.1] mmHg/mL increase with pulmonary embolism; - 0.2 [- 0.4 to 0.0] mmHg/mL with hypoxic pulmonary vasoconstriction, p > 0.05). Extracorporeal flow did not change coupling (0.0 [- 0.0 to 0.1] per change of 1 L/min, p > 0.05). End-diastolic volume increased with decreasing extracorporeal flow (7.2 [6.6 to 7.8] ml change per 1 L/min, p < 0.001)., Conclusions: The right ventricle dilates with increased preload and increases its contractility in response to afterload changes to maintain ventricular-arterial coupling during VA extracorporeal membrane oxygenation., (© 2024. The Author(s).)
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- 2024
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42. Transcatheter aortic valve implantation for left ventricular assist device-related aortic regurgitation.
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Tomii D, Reineke D, Hunziker L, and Pilgrim T
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- Humans, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve physiopathology, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency surgery, Heart-Assist Devices adverse effects, Heart Valve Prosthesis Implantation instrumentation
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- 2024
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43. Pretreatment With P2Y 12 Inhibitors in ST-Segment Elevation Myocardial Infarction: Insights From the Bern-PCI Registry.
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Rohla M, Ye SX, Shibutani H, Bruno J, Otsuka T, Häner JD, Bär S, Temperli F, Kavaliauskaite R, Lanz J, Stortecky S, Praz F, Hunziker L, Pilgrim T, Siontis GC, Losdat S, Windecker S, and Räber L
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- Humans, Female, Middle Aged, Aged, Male, Cohort Studies, Prospective Studies, Treatment Outcome, Registries, Percutaneous Coronary Intervention adverse effects, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction therapy
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Background: Evidence to support immediate P2Y
12 inhibitor loading in ST-segment elevation myocardial infarction (STEMI) is limited., Objectives: This study sought to compare outcomes of STEMI patients receiving immediate or delayed P2Y12 inhibitor treatment., Methods: Using data from the prospective Bern-PCI registry between 2016 and 2020, we stratified STEMI patients undergoing percutaneous coronary intervention according to time periods with different institutional recommendations regarding P2Y12 inhibitor pretreatment. In cohort 1 (October 2016-September 2018), immediate P2Y12 inhibitor treatment was recommended. In cohort 2 (October 2018-September 2020), P2Y12 inhibitor treatment was recommended after coronary anatomy was confirmed. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events (MACCEs) defined as all-cause death, recurrent myocardial infarction, stroke, or definite stent thrombosis at 30 days. Sensitivity analysis included only patients in whom these recommendations were followed., Results: Cohort 1 included 1,116 patients; pretreatment was actually given in 708 (63.4%). Cohort 2 included 847 patients; pretreatment was withheld in 798 (94.2%). The mean age was 65 ± 13 years, and 24% were female. Baseline characteristics were well-balanced between groups. The median difference for P2Y12 loading to angiography was 52 minutes between cohort 1 and 2 and 100 minutes between patients receiving vs not receiving pretreatment. Rates of MACCEs were similar between cohort 1 and cohort 2 (10.1% vs 8.1%; adjusted HR: 0.91; 95% CI: 0.65-1.28; P = 0.59) and between patients receiving vs not receiving pretreatment (7.1% vs 8.4%; adjusted HR: 1.17; 95% CI: 0.78-1.74; P = 0.45)., Conclusions: In this cohort study of patients with STEMI undergoing primary percutaneous coronary intervention, P2Y12 inhibitor pretreatment was not associated with improved MACCEs., Competing Interests: Funding Support and Author Disclosures Dr Rohla has received advisory fees from Daiichi Sankyo, Sanofi Aventis, COR2ED, Novartis and Medtronic; and has received lecturing fees from Daiichi Sankyo, Biotronik, and Takeda Pharma, all outside of the submitted work. Dr Stortecky has received research grants to the institution from Edwards Lifesciences, Medtronic, Abbott Vascular, and Boston Scientific; and has received speaker fees from Boston Scientific. Dr Praz has received travel expenses from Abbott Vascular, Polares Medical, and Edwards Lifesciences. Dr Pilgrim has received research grants to the institution from Medtronic, Abbott, Biotronik, Boston Scientific, and Edwards Lifesciences; and has received speaker fees/consultancy from Medtronic, Biotronik, Boston Scientific, Abbott, and HighLife SAS. Dr Windecker reports research, travel, or educational grants to the institution without personal remuneration from Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Braun, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Cordis Medical, Corflow Therapeutics, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Farapulse Inc Fumedica, Guerbet, Idorsia, Inari Medical, InfraRedx, Janssen-Cilag, Johnson & Johnson, Medalliance, Medicure, Medtronic, Merck Sharp and Dohm, Miracor Medical, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pharming Tech. Pfizer, Polares, Regeneron, Sanofi-Aventis, Servier, Sinomed, Terumo, Vifor, and V-Wave; has served as an advisory board member and/or member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, and V-Wave with payments to the institution but no personal payments; is member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration; is vice president of the European Society of Cardiology; and is associate editor of the JACC: Cardiovascular Interventions. Dr Räber has received research grants to the institution by Abbott, Biotronik, Heartflow, Sanofi, and Regeneron; and has received speaker/consultation fees from Abbott, Amgen, AstraZeneca, Canon, Novo Nordisk, Medtronic, Sanofi, Occlutech, and Vifor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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44. Quantitative Flow Ratio to Predict Non-Target-Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome.
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Bär S, Kavaliauskaite R, Otsuka T, Ueki Y, Häner J, Lanz J, Fürholz M, Praz F, Hunziker L, Siontis GC, Pilgrim T, Stortecky S, Losdat S, Windecker S, and Räber L
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- Humans, Cohort Studies, Coronary Angiography, Risk Factors, Time Factors, Treatment Outcome, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome surgery, Coronary Artery Disease, Percutaneous Coronary Intervention methods
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Background: The optimal time point of staged percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative flow ratio (QFR) is a novel noninvasive method to assess the hemodynamic significance of coronary stenoses. We aimed to investigate whether QFR could refine the timing of staged PCI of non-target vessels (non-TVs) on top of clinical judgment for patients with ACS., Methods and Results: For this cohort study, patients with ACS from Bern University Hospital, Switzerland, scheduled to undergo out-of-hospital non-TV staged PCI were eligible. The primary end point was the composite of non-TV myocardial infarction and urgent unplanned non-TV PCI before planned staged PCI. The association between lowest QFR per patient measured in the non-TV (from index angiogram) and the primary end point was assessed using multivariable adjusted Cox proportional hazards regressions with QFR included as linear or penalized spline (nonlinear) term. QFR was measured in 1093 of 1432 patients with ACS scheduled to undergo non-TV staged PCI. Median time to staged PCI was 28 days. The primary end point occurred in 5% of the patients. In multivariable analysis (1018 patients), there was no independent association between non-TV QFR and the primary end point (hazard ratio, 0.87 [95% CI, 0.69-1.05] per 0.1 increase; P =0.125; nonlinear P =0.648)., Conclusions: In selected patients with ACS scheduled to undergo staged PCI at a median of 4 weeks after index PCI, QFR did not emerge as an independent predictor of non-TV events before planned staged PCI. Thus, this study does not provide conceptual evidence that QFR is helpful to refine the timing of staged PCI on top of clinical judgment., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.
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- 2024
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45. Acute Heart Failure During the Peripartum Period Due to Aggravated Tricuspid Regurgitation.
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Samim D, Dernektsi C, Madhkour R, Brugger N, Elchinova E, Schwitz F, Jacky AES, Baumann M, Hunziker L, and Praz F
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Latent valvular heart disease may be aggravated or demasked during pregnancy because of physiologic hemodynamic changes, including higher circulating volume, heart rate, and cardiac index, as well as stress during labor. The presence of valvular heart disease increases the risk of maternal and fetal/newborn adverse events. Early diagnosis, risk assessment, and specific management are crucial. We present a case of acute peripartal heart failure caused by idiopathic severe tricuspid regurgitation in a 38-year-old woman., Competing Interests: Dr Samim has received funding for an online course from Edwards Lifesciences. Dr Praz has been compensated for travel expenses from Edwards Lifesciences, Abbott Vascular, Medira, Polares Medical, and Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2023 The Authors.)
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- 2023
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46. Impact of type 2 diabetes on life expectancy and role of kidney disease among inpatients with heart failure in Switzerland: an ambispective cohort study.
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Salvador D Jr, Bano A, Wehrli F, Gonzalez-Jaramillo V, Laimer M, Hunziker L, and Muka T
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- Aged, Middle Aged, Humans, Inpatients, Switzerland epidemiology, Cohort Studies, Life Expectancy, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 epidemiology, Heart Failure diagnosis, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic epidemiology
- Abstract
Background: Type 2 diabetes (T2D) is expected to worsen the prognosis of inpatients with heart failure (HF) but the evidence from observational studies is inconsistent. We aimed to compare mortality outcomes and life expectancy among inpatients with HF with or without T2D and explored whether chronic kidney disease (CKD) influenced these associations., Methods: We collected hospital and civil registry records of consecutive inpatients from a tertiary hospital in Switzerland with a diagnosis of HF from the year 2015 to 2019. We evaluated the association of T2D with mortality risk using Cox regression and adjusted for confounders., Results: Our final cohort consisted of 10,532 patients with HF of whom 27% had T2D. The median age (interquartile range [IQR]) was 75 [68 to 82] and 78 [68 to 86] for the diabetes and non-diabetes groups, respectively. Over a median follow-up [IQR] of 4.5 years [3.3 to 5.6], 5,347 (51%) of patients died. T2D patients had higher risk of all-cause mortality (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.14 to 1.29). Compared to control (i.e. no T2D nor CKD), average life expectancy (95% CI) among T2D patients, CKD, or both was shorter by 5.4 months (95% CI 1.1 to 9.7), 9.0 months (95% CI 8.4 to 9.6), or 14.8 months (95% CI 12.4 to 17.2), respectively. No difference by sex or ejection fraction category was observed., Conclusions: T2D is associated with a significantly higher risk of all-cause mortality and shorter life expectancy compared to those without among middle-aged and elderly inpatients with HF; presence of CKD may further increase these risks., (© 2023. The Author(s).)
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- 2023
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47. Ten-year retrospective cohort analysis of ventricular assist device infections.
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Spano G, Buffle E, Walti LN, Mihalj M, Cameron DR, Martinelli M, Fürholz M, Que YA, Hayward C, Reineke D, Hunziker L, and Schnegg B
- Subjects
- Male, Humans, Female, Middle Aged, Retrospective Studies, Cohort Studies, Risk Factors, Treatment Outcome, Heart-Assist Devices adverse effects, Heart-Assist Devices microbiology, Diabetes Mellitus, Heart Failure surgery, Heart Failure etiology
- Abstract
Background: The number of patients treated by ventricular assist devices (VAD) and the duration of VAD treatment is increasing. One of the main complications in terms of morbidity and mortality for VAD patients are microbial infections. With this study, we aimed to investigate the epidemiology and microbiological characteristics of infections occurring in a VAD population to identify modifiable factors., Methods: We retrospectively analyzed patient characteristics, treatments and outcomes of VAD-specific/related infections. All patients implanted in our institution with a continuous flow VAD between January 2009 and January 2019 were included. Risk factors for VAD infection were assessed using simple and multiple linear regressions., Results: Of the 104 patients screened, 99 were included in the analysis, the majority of which were men (78%). At implantation, the mean age was 56 years and the median time on VAD support was 541 days. The overall infection rate per year per patient was 1.4. Forty-seven patients (60%) suffered from VAD-specific/related infection. Half of all infection episodes occurred in the first 4 months but the proportion of VAD-specific/related infection was higher after the first 4 months (74% of all infection). Using regression models, no patient specific risk factors were associated with VAD-specific/related infections., Conclusion: No predictive factors for infection during VAD support were identified in this study. By extension, diabetes, renal insufficiency, age or high BMI are not sufficient to deny a patient access to ventricular support., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
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- 2023
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48. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure.
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Norhammar A, Bodegard J, Vanderheyden M, Tangri N, Karasik A, Maggioni AP, Sveen KA, Taveira-Gomes T, Botana M, Hunziker L, Thuresson M, Banerjee A, Sundström J, and Bollmann A
- Subjects
- Adult, Humans, Aged, Prevalence, Ventricular Function, Left, Stroke Volume, Heart Failure, Renal Insufficiency, Chronic epidemiology
- Abstract
Objective: Digital healthcare systems could provide insights into the global prevalence of heart failure (HF). We designed the CardioRenal and Metabolic disease (CaReMe) HF study to estimate the prevalence, key clinical adverse outcomes and costs of HF across 11 countries., Methods: Individual level data from a contemporary cohort of 6 29 624 patients with diagnosed HF was obtained from digital healthcare systems in participating countries using a prespecified, common study plan, and summarised using a random effects meta-analysis. A broad definition of HF (any registered HF diagnosis) and a strict definition (history of hospitalisation for HF) were used. Event rates were reported per 100 patient years. Cumulative hospital care costs per patient were calculated for a period of up to 5 years., Results: The prevalence of HF was 2.01% (95% CI 1.65 to 2.36) and 1.05% (0.85 to 1.25) according to the broad and strict definitions, respectively. In patients with HF (broad definition), mean age was 75.2 years (95% CI 74.0 to 76.4), 48.8% (40.9-56.8%) had ischaemic heart disease and 34.5% (29.4-39.6%) had diabetes. In 51 442 patients with a recorded ejection fraction (EF), 39.1% (30.3-47.8%) had a reduced, 18.8% (13.5-24.0%) had a mildly reduced and 42.1% (31.5-52.8%) had a preserved left ventricular EF. In 1 69 518 patients with recorded estimated glomerular filtration rate, 49% had chronic kidney disease (CKD) stages III-V. Event rates were highest for cardiorenal disease (HF or CKD) and all cause mortality (19.3 (95% CI 11.3 to 27.1) and 13.1 (11.1 to 15.1), respectively), and lower for myocardial infarction, stroke and peripheral artery disease. Hospital care costs were highest for cardiorenal diseases., Conclusions: We estimate that 1-2% of the contemporary adult population has HF. These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD. There is considerable public health potential in understanding the contemporary burden of HF and the importance of optimising its management., Competing Interests: Competing interests: AN has received honoraria from MSD, AstraZeneca, Eli Lilly, Boehringer Ingelheim and Novo Nordisk. JB holds a full time position at AstraZeneca as an epidemiologist. NT reports grants and personal fees from AstraZeneca, grants and personal fees from Janssen, grants and personal fees from BI-Lilly, grants and personal fees from Otsuka, grants, personal fees and other from Tricida, personal fees and other from Pulsedata, personal fees and other from Mesentech, personal fees and other from Renibus, and other from ClinPredict, outside the submitted work; NT has a patent for a microfluidic device for point of care detection of urine albumin pending. AK has received research grants and speaking honoraria from Astrazeneca, Novonordisk and Boehringer Ingelheim. APM reports receiving fees for serving on study committees from AstraZeneca, Novartis, Bayer and Fresenius, outside the present work. TT-G declares speaker and consulting fees from AstraZeneca, BIAL, Daiichi-Sankyo, MSD, Medinfar and Novartis; TT-G holds shares in MTG. MB has received honoraria from Astra Zeneca, Janssen, Lilly, Boehringer Ingelheim, Sanofi, Amgen and Novo Nordisk. MT holds a full time position by an independent statistical consultant company, Statisticon AB, Uppsala, Sweden, of which AstraZeneca Nordic is a client. JS reports stock ownership in companies providing services to Itrim, Amgen, Janssen, Novo Nordisk, Eli Lilly, Boehringer, Bayer, Pfizer, Takeda and AstraZeneca, outside the submitted work. AB is supported by research funding from NIHR, British Medical Association, AstraZeneca and UK Research and Innovation. ABo is part of the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement No 116074; this joint undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. KAS has received speaking honoraria from Astrazeneca, Novonordisk, Sanofi and Boehringer Ingelheim., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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49. Acute Coronary Occlusion in Patients With Non-ST-Segment Elevation Out-of-Hospital Cardiac Arrest.
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Spirito A, Vaisnora L, Papadis A, Iacovelli F, Sardu C, Selberg A, Bär S, Kavaliauskaite R, Temperli F, Asatryan B, Pilgrim T, Hunziker L, Heg D, Valgimigli M, Windecker S, and Räber L
- Subjects
- Humans, Electrocardiography, Coronary Angiography adverse effects, Chest Pain etiology, Coronary Occlusion complications, Coronary Occlusion diagnosis, Out-of-Hospital Cardiac Arrest etiology, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation adverse effects, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: According to current guidelines, hemodynamic status should guide the decision between immediate and delayed coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation. A delayed strategy is advised in hemodynamically stable patients, and an immediate approach is recommended in unstable patients., Objectives: This study sought to assess the frequency, predictors, and clinical impact of acute coronary occlusion in hemodynamically stable and unstable OHCA patients without ST-segment elevation., Methods: Consecutive unconscious OHCA patients without ST-segment elevation who were undergoing CAG at Bern University Hospital (Bern, Switzerland) between 2011 and 2019 were included. Frequency and predictors of acute coronary artery occlusions and their impact on all-cause and cardiovascular mortality at 1 year were assessed., Results: Among the 386 patients, 169 (43.8%) were hemodynamically stable. Acute coronary occlusions were found in 19.5% of stable and 24.0% of unstable OHCA patients (P = 0.407), and the presence of these occlusions was predicted by initial chest pain and shockable rhythm, but not by hemodynamic status. Acute coronary occlusion was associated with an increased risk of cardiovascular death (adjusted HR: 2.74; 95% CI: 1.22-6.15) but not of all-cause death (adjusted HR: 0.72; 95% CI: 0.44-1.18). Hemodynamic instability was not predictive of fatal outcomes., Conclusions: Acute coronary artery occlusions were found in 1 in 5 OHCA patients without ST-segment elevation. The frequency of these occlusions did not differ between stable and unstable patients, and the occlusions were associated with a higher risk of cardiovascular death. In OHCA patients without ST-segment elevation, chest pain or shockable rhythm rather than hemodynamic status identifies patients with acute coronary occlusion., Competing Interests: Funding Support and Author Disclosures This study was supported by the Department of Cardiology at Bern University Hospital, Bern, Switzerland. Dr Spirito has received a research grant from the Swiss National Science Foundation. Dr Bär has received research grants from Medis Medical Imaging Systems, Abbott, Bangerter-Rhyner-Stiftung, and the Swiss National Science Foundation, outside the submitted work. Dr Valgimigli has received personal fees from AstraZeneca, Alvimedica/CID, Abbott Vascular, Daiichi-Sankyo, Bayer, CoreFLOW, Idorsia Pharmaceuticals, University of Basel Clinical Research Department, Vifor, Bristol Myers Squibb, Biotronik, Boston Scientific, Medtronic, Vesalio, Novartis, Chiesi, and PhaseBio; and has received grants and personal fees from Terumo, outside the submitted work. Dr Windecker has received research and educational grants to the institution from Abbott, Amgen, AstraZeneca, Bristol Myers Squibb, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi, Sinomed, Terumo, and V-Wave; has served as an unpaid advisory board member and/or unpaid member of the steering or executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer. Bristol Myers Squibb, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, Janssen, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, V-Wave, and Xeltis but has not received personal payments from pharmaceutical companies or device manufacturers; and is a member of the steering or executive committee group of several investigator-initiated trials that receive funding from industry without an impact on his personal remuneration. Dr Räber has received research grants to the institution from Abbott, Biotronik, Boston Scientific, Heartflow, Sanofi, and Regeneron; and has received speaker or consultation fees from Abbott, Amgen, AstraZeneca, Canon, Medtronic, NovoNordisk, Occlutech, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2023
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50. SGLT2 inhibitor therapy for transthyretin amyloid cardiomyopathy: early tolerance and clinical response to dapagliflozin.
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Dobner S, Bernhard B, Asatryan B, Windecker S, Stortecky S, Pilgrim T, Gräni C, and Hunziker L
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- Humans, Prealbumin, Stroke Volume, Retrospective Studies, Ventricular Function, Left, Amyloid Neuropathies, Familial drug therapy, Sodium-Glucose Transporter 2 Inhibitors therapeutic use, Cardiomyopathies drug therapy
- Abstract
Aims: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve clinical outcomes in heart failure patients with reduced and preserved left ventricular ejection fraction (LVEF), but have not yet been investigated in transthyretin amyloid cardiomyopathy (ATTR-CM). This study aimed to evaluate tolerability, clinical outcomes, and changes in NT-proBNP levels and glomerular filtration rate (GFR) in ATTR-CM patients treated with dapagliflozin., Methods and Results: Patients with stable, tafamidis-treated ATTR-CM were retrospectively evaluated at the initiation of dapagliflozin and 3 months thereafter. Tafamidis-treated ATTR-CM patients without SGLT2i served as a reference cohort. Overall, SLGT2i therapy was initiated in 34 patients. Seventeen patients with stable disease on tafamidis, who were subsequently started on dapagliflozin, were included in the analysis. Patients selected for SGLT2i presented with signs of advanced disease, evidenced by higher Gillmore disease stage (stage ≥2: 53% vs. 27.5%; P = 0.041), baseline median NT-proBNP [median (IQR) 2668 pg/mL (1314-3451) vs. 1424 (810-2059); P = 0.038] and loop diuretic demand (76.5% vs. 45% of patients; P = 0.044), and lower LVEF (46.6 ± 12.9 vs. 53.7 ± 8.7%; P = 0.019) and GFR (51.8 ± 16.5 vs. 68.5 ± 18.6 mL/min; P = 0.037) compared with the reference cohort. At 3-month follow-up, a numerical decrease in NT-proBNP levels was observed in 13/17 (76.5%) patients in the dapagliflozin (-190 pg/mL, IQR: -1,028-71, P = 0.557) and 27/40 (67.5%) of patients in the control cohort (-115 pg/mL, IQR: -357-105, P = 0.551). Other disease parameters remained stable and no adverse events occurred., Conclusions: In tafamidis-treated ATTR-CM patients, initiation of dapagliflozin was well tolerated. The efficacy of SGLT2i therapy in patients with ATTR-CM needs to be studied in randomized controlled trials., (© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2023
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