Search

Johannes Leiner,1,2 Vincent Pellissier,2 Sebastian König,1,2 Lars Stellmacher,2 Sven Hohenstein,2 Carolin Schanner,2 Stefan Kwast,2 Ralf Kuhlen,3,4 Andreas Bollmann1– 3 1Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Saxony, Germany; 2Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany; 3Helios Health Institute, Berlin, Germany; 4Helios Health, Berlin, GermanyCorrespondence: Johannes Leiner, Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Struempellstrasse 39, Leipzig, 04289, Germany, Tel +49 341 865 251573, Email johannes.leiner@helios-gesundheit.deIntroduction: Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD) globally. Both conditions substantially worsen patients’ prognosis. Current data on German in-hospital CKD cohorts are scarce. The multinational CaReMe study was initiated to evaluate the current epidemiology and healthcare burden of cardiovascular, renal and metabolic diseases. In this substudy, we share real-world data on CKD inpatients stratified for coexisting T2DM derived from a large German hospital network.Methods: This study used administrative data of inpatient cases from 89 Helios hospitals from 01/01/2016 to 28/02/2022. Data were extracted from ICD-10-encoded discharge diagnoses and OPS-encoded procedures. The first case meeting a previously developed CKD definition (defined by ICD-10- and OPS-codes) was considered the index case for a particular patient. Subsequent hospitalizations were analysed for readmission statistics. Patient characteristics and pre-defined endpoints were stratified for T2DM at index case.Results: In total, 48,011 patients with CKD were included in the present analysis (mean age ± standard deviation, 73.8 ± 13.1 years; female, 44%) of whom 47.9% had co-existing T2DM. Patients with T2DM were older (75 ± 10.6 vs 72.7 ± 14.9 years, p < 0.001), but gender distribution was similar to patients without T2DM. The burden of cardiovascular disease was increased in patients with T2DM, and index and follow-up in-hospital mortality rates were higher. Non-T2DM patients were characterised by more advanced CKD at baseline. Patients with T2DM had consistently higher readmission numbers for all events of interest, except for readmissions due to kidney failure/dialysis, which were more common in non-T2DM patients.Conclusion: In this study, we present recent data on hospitalized patients with CKD in Germany. In this CKD cohort, nearly half had T2DM, which substantially affected cardiovascular disease burden, rehospitalization frequency and mortality. Interestingly, non-diabetic patients had more advanced underlying renal disease, which affected renal outcomes. Keywords: chronic kidney disease, type 2 diabetes mellitus, administrative data, in-hospital mortality, kidney failure, rehospitalization

Aims: Heart failure (HF) and chronic kidney disease (CKD) place significant challenges on the healthcare system, and their co-existence is associated with shared adverse outcomes. The multinational CaReMe project was initiated to provide contemporary, real-world epidemiological data on cardiovascular and reno-metabolic diseases. Utilizing data from the German CaReMe cohort, we characterize a multicentric HF population and describe in-hospital outcomes stratified for co-morbid CKD., Methods and Results: This retrospective, observational study analysed administrative data from inpatient cases hospitalized in 87 German Helios hospitals between 1 January 2016 and 31 August 2022. The first hospitalization of patients aged ≥18 years with a primary discharge diagnosis of HF, based on ICD-10 codes, were considered the index cases, and subsequent hospitalizations were considered as readmissions. Baseline characteristics and outcomes were stratified for co-morbid CKD using ICD-10-encoding from the index cases. Cox regression was utilized for readmission endpoints and in-hospital mortality. In total, 174 829 index cases (mean age 79 ± 15 years, 49.9% female) were included; of these, 55.0% had coexisting CKD. Patients with CKD were older, suffered from worse HF-related symptoms, had a higher co-morbidity burden, and in-hospital mortality was increased at index and during follow-up. Prevalent CKD was associated with higher rehospitalization rates and was an independent predictor for in-hospital death., Conclusions: Within this HF inpatient cohort from a multicentric German database, CKD was diagnosed in more than half of the patients and was associated with increased in-hospital mortality at baseline and during follow-up. Rehospitalizations were observed earlier and more frequently in patients with HF and co-morbid CKD., (© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Chronic heart failure (CHF) is one of the most common diseases with a prevalence of 1-2% in adults, disproportionately affecting the elderly. Despite consistent drug therapy, physical activity (PA) is an integral part of current guidelines. Yet adherence to regular PA and exercise interventions is poor and potential predictors and barriers to PA remain elusive. We examined the effects of a telemonitoring-based exercise intervention in 699 CHF patients in a prospective, randomized-controlled (1:1), multicenter trial. The study was registered in the German Clinical Trials Register under DRKS00019022 on 28.05.2020. For both, the exercise and control group, self-reported PA (MET*h/week) increased and sedentary behavior declined during the 12-month intervention period. In the exercise group, daily step count as analyzed via activity trackers remained stable (pre: 6459 [4016] steps/day, post: 6532 [3858] steps/day; p = 0.621). The average number of completed exercise instruction videos provided via an online application was 1.50 [1.44] videos/week at the beginning and gradually decreased to 1.00 [1.50] videos/week; p < 0.001). Multivariate regression model revealed that exercise-related PA (MET*h/week) and exercise capacity (W max ) at baseline, CHF severity, atrial fibrillation and age predicted changes in self-reported exercise-related PA (R 2  = 0.396). Furthermore, the BMI and the average number of completed videos per week at baseline were associated with the change in completed videos over the course of the study (R 2  = 0.251). Our results show the influence of certain baseline characteristics as barriers and predictors of PA progression. Therefore, exercise programs should pay attention to patients' individual conditions to set achievable goals, and eventually affect the adherence and sustainability of exercise-focused interventions., (© 2024. The Author(s).)

Aims: Endemic SARS-CoV-2 infections still burden the healthcare system and represent a considerable threat to vulnerable patient cohorts, in particular immunocompromised (IC) patients. This study aimed to analyze the in-hospital outcome of IC patients with severe SARS-CoV-2 infection in Germany., Methods: This retrospective, observational study, analyzed administrative data from inpatient cases ( n = 146,324) in 84 German Helios hospitals between 1 January 2022 and 31 December 2022 with regard to in-hospital outcome and health care burden in IC patients during the first 12 months of Omicron dominance. As the primary objective, in-hospital outcomes of patients with COVID-19-related severe acute respiratory infection (SARI) were analyzed by comparing patients with ( n = 2037) and without IC diagnoses ( n = 14,772). Secondary analyses were conducted on IC patients with ( n = 2037) and without COVID-19-related SARI ( n = 129,515). A severe in-hospital outcome as a composite endpoint was defined per the WHO definition if one of the following criteria were met: intensive care unit (ICU) treatment, mechanical ventilation (MV), or in-hospital death., Results: In total, 12% of COVID-related SARI cases were IC patients, accounting for 15% of ICU admissions, 15% of MV use, and 16% of deaths, resulting in a higher prevalence of severe in-hospital courses in IC patients developing COVID-19-related SARI compared to non-IC patients (Odds Ratio, OR = 1.4, p < 0.001), based on higher in-hospital mortality (OR = 1.4, p < 0.001), increased need for ICU treatment (OR = 1.3, p < 0.001) and mechanical ventilation (OR = 1.2, p < 0.001). Among IC patients, COVID-19-related SARI profoundly increased the risk for severe courses (OR = 4.0, p < 0.001)., Conclusions: Our findings highlight the vulnerability of IC patients to severe COVID-19. The persistently high prevalence of severe outcomes in these patients in the Omicron era emphasizes the necessity for continuous in-hospital risk assessment and monitoring of IC patients.

Periodontal disease (PD) is considered a risk factor for cardiovascular events. However, its relationship to chronic heart failure (CHF) is unclear. The aim was to compare cardiac and inflammatory parameters in CHF patients with (PG) versus without periodontitis (NPG). The following parameters were recorded in 58 patients: periodontal screening and recording (PSR), troponin T, NT-proBNP, C-reactive protein (CRP), interleukin-6 (IL-6), blood pressure, heart rate, ejection fraction (EF), ventricular systolic and diastolic function parameters, incremental test, and three questionnaires (Mediterranean Diet Adherence Screener, MEDAS; Oral Health Impact Profile, OHIP-14; Patient Health Questionnaire, PHQ). The serum levels of NT-proBNP and troponin T were significantly higher in the PG, and the left ventricular systolic and diastolic function parameters were significantly lower. The correlation analysis showed age as the only independent risk factor for periodontitis and cardiac biomarkers. No significant group differences were found in the MEDAS, OHIP-14, and PHQ scores, or in CRP, IL-6, and cardiocirculatory parameters. Overall, the BMI correlated significantly with the mean PSR and total cholesterol. The occurrence of increased PSR together with increased age and cardiac risk parameters does not exclude an association between periodontitis and CHF, though no positive correlation was calculated. Periodontitis may be a modifiable risk factor for CHF. Its treatment may help to control the inflammatory burden.

Background: Visceral adipose tissue (VAT) has been linked to systemic proinflammatory characteristics, and measuring it accurately usually requires sophisticated instruments. This study aimed to estimate VAT applying a simpler method that uses total subcutaneous fat and total body fat (BF) measurements., Method: As part of our experimental approach, the subcutaneous fat mass (SFT) was measured via US (SFT total ), and VAT was quantified by assessing MRI data. Both parameters were added to obtain total body fat (BF calc ). Those results were then compared to values obtained from a bioelectrical impedance analysis (BF BIA ). Multiple regression analyses were employed to develop a simplified sex-specific equation for SFT, which was subsequently used in conjunction with BF BIA to determine VAT (VAT Eq )., Result: We observed excellent reliability between BF BIA and BF calc , with no significant difference in body fat values (20.98 ± 8.36 kg vs. 21.08 ± 8.81 kg, p = 0.798, ICC 0.948). VAT Eq&#95;female/male revealed excellent reliability when compared to VAT MRI, and no significant difference appeared (women: 0.03 ± 0.66 kg with a 95% CI ranging from -1.26 kg to 1.32 kg, p = 0.815, ICC: 0.955.; men: -0.01 ± 0.85 kg with a 95% CI ranging from -1.69 kg to 1.66 kg, p = 0.925, ICC: 0.952)., Conclusion: Taking an experimental approach, VAT can be determined without MRI., (© 2023. The Author(s).)

In addition to drug therapy, lifestyle modification, including physical activity, and nutrition management are an integral part of current guidelines for patients with chronic heart failure (CHF). However, evidence on which clinical parameters are most influenced by nutritional behaviour, exercise capacity, or iron status is scarce. For a multicenter intervention study, we included participants with diagnosed CHF ( n = 165) as well as participants with elevated NT-proBNP values and risk factors for CHF ( n = 74). Cardiorespiratory fitness was tested with a bicycle test, and adherence to the Mediterranean diet (MedDiet) was assessed with the MDS questionnaire. Our data strengthened previous results confirming that the higher a person's adherence to MedDiet, the higher the cardiorespiratory fitness and the lower the body fat. Furthermore, our results showed that anemia in patients with CHF has an impact in terms of cardiorespiratory fitness, and functional outcomes by questionnaire. Since our data revealed gaps in iron supply (37.9% with iron deficiency), malnutrition (only 7.8% with high adherence to MedDiet), and both symptomatic and non-symptomatic study participants failed to meet reference values for physical performance, we encourage the enforcement of the guidelines in the treatment of CHF more strongly., Competing Interests: The authors declare that they have no competing interests.

Caliper and ultrasound (US) are used to measure subcutaneous fat tissue depth (SFT) and then to calculate total body fat. There is no evidence-based recommendation as to whether caliper or US are equally accurate. The aim of this paper was therefore to compare reliability of both methods. In this methodical study, 54 participants (BMI: 24.8 ± 3.5 kg/m 2 ; Age: 43.2 ± 21.7 years) were included. Using systematic body mapping, the SFT of 56 areas was measured. We also analyzed 4 body sites via MRI. A comparison between caliper and US detected clear differences in mean SFT of all areas (0.83 ± 0.33 cm vs. 1.14 ± 0.54 cm; p < 0.001) showing moderate reliability (ICC 0.669, 95%CI: 0.625-0.712). US and MRI revealed in the abdominal area a SFT twice as thick as caliper (2.43 ± 1.36 cm vs. 2.26 ± 1.32 cm vs. 1.15 ± 0.66 cm; respectively). Caliper and US revealed excellent intrarater (ICC caliper: 0.944, 95%CI: 0.926-0.963; US: 0.934, 95%CI: 0.924-0.944) and good interrater reliability (ICC caliper: 0.794, 95%CI: 0.754-0.835; US: 0.825, 95%CI: 0.794-0.857). Despite the high reliability in measuring SFT that caliper and US show, our comparison of the two methods yielded clear differences in SFT, particularly in the abdominal area. In accuracy terms, US is preferable for most mapping areas., (© 2022. The Author(s).)

Background: Novel intraoperative imaging techniques, namely, hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, thus increasing patient safety. Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. To our knowledge, this is the first study evaluating both modalities simultaneously during esophagectomy., Methods: In our pilot study, 13 patients, who underwent Ivor Lewis esophagectomy and gastric conduit reconstruction, were analyzed prospectively. HSI and FI were recorded before establishing the anastomosis in order to determine its optimum position., Results: No anastomotic leak occurred during this pilot study. In five patients, the imaging methods resulted in a more peripheral adaptation of the anastomosis. There were no significant differences between the two imaging tools, and no adverse events due to the imaging methods or indocyanine green (ICG) injection occurred., Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming. They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort.

Background: Some studies have suggested that a mouthguard is a performance-enhancing device due to a remote voluntary contraction. The extent to which a mouthguard can induce this phenomenon, e.g., by potentially increasing biting, has not been clarified. This study's aim was to investigate the muscular activity of the maxillary and peripheral musculature and motor performance during a rest and exercise test., Methods: Our study comprised 12 active, male, professional young handball players (age 18.83 ± 0.39 years). Their performance, electromyographic (EMG) muscle activity (Σ), and lateral deviation (Δ) of the masticatory and peripheral musculature were measured during rest in a maximum bite force measurement, one-legged stand, a kettlebell swing exercise and a jump test while wearing a customized mouthguard (CMG) or not wearing one (Co)., Results: Maximum bite force measurements did not differ significantly in their mean values of muscle activity (Σ) for the masseter and temporalis muscles (Co 647.6 ± 212.8 µV vs. CMG 724.3 ± 257.1 µV p = 0.08) (Co 457.2 ± 135.5 µV vs. CMG 426.6 ± 169.3 µV p = 0.38) with versus without CMG. We found no differences in the mean activation values during a one-legged stand, the kettlebell swing, and jump test (Σ) in any of the muscles tested. Lateral deviations (Δ) wearing a CMG were significantly less in the erector spinae during the kettlebell swing (Co 5.33 ± 3.4 µV vs. CMG 2.53 ± 1.8 µV p = 0.01) and countermovement jump (Co 37.90 ± 30.6 µV vs. CMG 17.83 ± 22.3 µV p = 0.03) compared to the performance without a CMG. Jump height, rotation moment, and balance were unchanged with versus without CMG., Conclusion: Our results at rest and during specific motor stress show no differences with or without a CMG. The improved peripheral muscular balance while wearing a CMG indicates improved muscular stabilization., (© 2021. The Author(s).)

The importance of using mouthguards as well as their low acceptance rate have been demonstrated. The aim of this study was to investigate the influence of customized mouthguards on hemodynamics.. This randomized crossover study used data from 13 subjects (23.5±1.4 years). The cardiopulmonary and metabolic parameters were observed during ergometer tests without mouthguard (control) in comparison to two types of mouthguards (with and normal without breathing channels). Maximum ventilation was significantly decreased with the normal mouthguard (113.3±30.00 l ∙ min -1 ) in contrast to the mouthguard with breathing channels (122.5±22.9 l ∙ min -1 ) and control (121.9±30.8 l ∙ min -1 ). Also the inspiration time was longer when using the normal mouthguard (0.70±0.11 s) compared to the mouthguard with breathing channels (0.63±0.11 s) and control (Co 0.64±0.10 s). Lactate was also increased under the influence of the mouthguard with breathing channels (10.72±1.4 mmol ∙ l -1 ) compared to the control (9.40±1.77 mmol ∙ l -1 ) and the normal mouthguard (9.02±1.67 mmol ∙ l -1 ). In addition, stroke volume kinetics (p=0.048) and maximum heart rates (p=0.01) show changes. Despite equal levels of oxygen uptake and performances under all three conditions, the use of mouthguards showed differences in cardiopulmonary parameters. The use of mouthguards during exercise does not affect physical performance and can be recommended for injury prevention., Competing Interests: The authors declare that they have no competing interests., (Thieme. All rights reserved.)

Background: The importance of mouthguards for handball players has been proven however, most players are reluctant to use it. The impact on physical capacity is assessed heterogeneously in the literature. This study aimed to investigate the influence of custom-made mouthguards (CMGs) under handball specific stress., Methods: This randomized crossover study used data from 15 youth professional handball players (age 17.0 ±0.5 years, weight 85.1±8.0 kg and height 191.2±6.9 cm) who performed a validated handball specific course and a lung function test. Pulmonary (spirometry), metabolic (blood lactate), and cortisol parameters were observed using a normal custom-made mouthguard without (nCMG) and with respiratory channels (CMGvent) in comparison to no mouthguard (Co)., Results: In resting spirometry, no differences in the parameter peak flow were observed using the CMGvent (9.57±1.59 l·s-1) and nCMG (9.17±1.03 l·s-1) in comparison to the Co (9.38±1.26 l·s-1). Under maximum stress, there were no differences in ventilation using CMGvent (151.2±15.64 L ·min-1), nCMG (148.6±12.51 l·min-1), and without mouthguard (145.8±14.32 l·min-1). Similar oxygen uptake was observed when using a CMGvent (45.51±4.14 L ·min-1·kg-1), nCMG (45.50±5.06 ml·min-1 ·kg-1), and without CMG (Co 43.90±4.02 mL ·min-1). The parameters of HR (CMGvent 185.2±11.63 bpm vs. Co 179.4±13.24 bpm p=0.46, nCMG 178.2±11.54 bpm vs. Co p=0.97; CMGvent vs. nCMG p=0.08) and in the blood lactate values (CMGvent: 9.66±2.3 mmol·l-1 vs. Co 9.07±2.1 mmol·l-1 p=0.63; nCMG 9.39±2.8 mmol·l-1 vs. Co p=0.87; CMGvent vs. nCMG p=0.91) displayed no differences. The cortisol production under stress showed no differences in the performance with the CMGvent (1.78±3.58 ng/ml), nCMG (0.74±4.52 ng/mL), and in the procedure without mouthguard (0.25. ±5.01 ng/ml)., Conclusion: The results showed that under stress, there were no differences in the cortisol, ventilation, cardiac, and metabolic responses for all three conditions. Finally, the study shows that the use of a custom-made mouthguard does not negatively affect handball specific performance. Due to the preventive aspect of the mouthguard, the use of a custom-made mouthguard in handball is strongly recommended., Competing Interests: Declaration of Competing Interest none, (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Schulze, A, Laessing, J, Kwast, S, and Busse, M. Influence of a vented mouthguard on physiological responses in handball. J Strength Cond Res 34(7): 2055-2061, 2020-Mouthguards (MGs) improve sports safety. However, airway obstruction and a resulting decrease in performance are theoretical disadvantages regarding their use. The study aim was to assess possible limitations of a "vented" MG on aerobic performance in handball. The physiological effects were investigated in 14 male professional players in a newly developed handball-specific course. The measured values were oxygen uptake, ventilation, heart rate, and lactate. Similar oxygen uptake (V[Combining Dot Above]O2) values were observed with and without MG use (51.9 ± 6.4 L·min·kg vs. 52.1 ± 10.9 L·min·kg). During maximum load, ventilation was markedly lower with the vented MG (153.1 ± 25 L·min vs. 166.3 ± 20.8 L·min). The endexpiratory concentrations of O2 (17.2 ± 0.5% vs. 17.6 ± 0.8%) and CO2 (4.0 ± 0.5% vs. 3.7 ± 0.6%) were significantly lower and higher, respectively, when using the MG. The inspiration and expiration times with and without the MG were 0.6 ± 0.1 seconds vs. 0.6 ± 0.1 seconds and 0.7 ± 0.2 seconds vs. 0.6 ± 0.2 seconds (all not significant), respectively, indicating that there was no relevant airflow restriction. The maximum load was not significantly affected by the MG. The lower ventilation for given V[Combining Dot Above]O2 values associated with MG use may be an effect of improved biomechanics and lower respiratory drive of the peripheral musculature.

Mouthguards (MGs) are highly recommended in rugby. Airway obstruction and a resulting decrease in power output are potential disadvantages of their usage. The aim of the study was to assess possible limitations of "vented" (MG V ) and custom-made mouthguards (MG C ) on rugby players' performance. The MG effects were investigated in 13 male first-league rugby players ranging from 18-34 years old. First a lung function test was completed. Then a double incremental treadmill test was performed to measure maximum aerobic performance, ventilation, VO 2 , VCO 2 , heart rate, and lactate. Effects on sprint times (10 and 40 m) and countermovement jumps were also investigated. Peak flow values were significantly decreased with MG V by about 0.9 l/s. Neither ventilatory parameters nor oxygen uptake were affected by either of the mouthguards. Maximum lactate was significantly decreased in both MG types vs. no MG use. The maximum running velocity was similar in all tests. The aerobic energy turnover was moderately increased with the MG C and MG V . No effects were seen on sprint times or jump tests. Although neither type of mouthguard had a significant impact on maximum performance in treadmill running, the anaerobic energy turnover was decreased.