382 results on '"S. Desch"'
Search Results
2. Prognostic significance of left atrial reservoir strain in patients undergoing transcatheter aortic valve implantation
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M Von Roeder, M Maeder, V Wahl, G Stachel, H Thiele, S Desch, P Lurz, and M Abdel-Wahab
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Funding Acknowledgements Type of funding sources: None. Background Left atrial reservoir strain (LARS) provides prognostic information in various patient groups and might help to detect elevated filling pressures. Patients with diastolic dysfunction experience worse outcomes after transcatheter aortic valve implantation (TAVI), but Doppler-derived measurements might be hampered by atrial fibrillation, mitral valve disease or impaired image quality. Aim of the current study is to elucidate the prognostic value of LASR in patients undergoing TAVI. Methods All consecutive patients undergoing TAVI at a single tertiary care hospital between 01/2018 and 12/2018 were included if discharge echo and follow-up was available. LASR was derived from 2-D-speckle-tracking averaged apical 2- and 4-chamber view. Patients were grouped in 3 tertiles according to LASR. Primary outcome was a composite of all-cause death and readmission for worsening heart failure. Results Overall, 606 patients were available (Age 80 years (IQR 77-84)), including 53% woman. LASR was significantly impaired over tertiles (T1 21.4 (IQR 18.3-24.5), T2 13.0 (IQR 11.3-14.6), T3 7.1 (IQR 5.4-8.4), p On multivariable Cox-regression analysis LASR was a significant factor to predict outcome (HR 0.95, CI 0.91-0.99, p = 0.02). Conclusion Impaired LASR is associated with impaired outcomes in patients undergoing TAVI.
- Published
- 2022
3. Outflow Graft Occlusion with Vascular Plug as Interventional Alternative for LVAD Discontinuation
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Hans-Hinrich Sievers, Stefan Klotz, S. Desch, Sina Stock, and A. Karluss
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Graft occlusion ,business.industry ,medicine ,Surgery ,Vascular plug ,Outflow ,Cardiology and Cardiovascular Medicine ,business ,Discontinuation - Published
- 2018
4. Combined Coronary CT-angiography And TAVI-planning For Ruling-out Significant Coronary Artery Disease: Added Value Of Machine-Learning Based CT-FFR
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R. Gohmann, K. Pawelka, P. Seitz, N. Majunke, S. Desch, P. Lauten, D. Holzhey, T. Noak, P. Kiefer, C. Krieghoff, S. Gottschling, C. Lücke, J. Wilde, S. Ebel, M. Borger, H. Thiele, M. Abdel-Wahab, and M. Gutberlet
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2021
5. P5567Clinical characteristics, diagnosis and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair
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P Lurz, K P Rommel, M Orban, C Besler, D Braun, F Schlotter, T Noack, S Desch, M Borger, S Massberg, J Hausleiter, and H Thiele
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Cardiology and Cardiovascular Medicine - Abstract
Objective To assess the role of pulmonary hypertension (PHT) in severe tricuspid regurgitation (TR) and its implications for transcatheter tricuspid valve repair (TTVR). Background PHT patients are often excluded from surgical TR therapies. TTVR with the MitraClipTM technique is a novel treatment option for these patients. Methods A total of 164 patients at high surgical risk (median age 78 years) and TR underwent TTVR at two centers. Seventy patients were grouped as iPHT+, defined as invasive systolic pulmonary artery pressure (PAPs) >50 mmHg. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, reintervention) was investigated. Results iPHT+ patients were at higher pre-operative risk (p Procedural TTVR success was achieved in 86 vs. 82% in iPHT+ and iPHT- patients respectively (p=0.52). Tricuspid valve effective regurgitant orifice area (EROA) was reduced from 0.49 cm2 to 0.20 cm2 (p While iPHT+ conveyed risk (HR 1.7 (95% CI 1.1–2.8), p=0.03) for the occurrence of the clinical endpoint, ePHT+ paradoxically conveyed protection (HR 0.61 (95% CI 0.36–0.98), p=0.04). This discrepancy was explained by the highest event rates in patients with iPHT+/ePHT- (n=28). Conversely, iPHT+/ePHT+ patients had comparable outcomes to iPHT- patients. Conclusions PHT in TR is associated with worse clinical status and advanced HF, but not procedural failure. Symptomatic benefit can be achieved irrespective of PHT status by TTVR. Although echocardiographic PHT diagnosis is unreliable, the combination of echocardiographic and invasive assessment may identify ideal candidates for TTVR among PHT patients.
- Published
- 2019
6. 550Determinants and prognostic value of cardiac magnetic resonance imaging derived infarct characteristics in non-ST-elevation myocardial infarction
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H-J Feistritzer, I Eitel, A Jobs, S De Waha-Thiele, R Meyer-Saraei, A Freund, T Stiermaier, M Abdel-Wahab, P Lurz, S J Reinstadler, M Reindl, G Klug, B Metzler, S Desch, and H Thiele
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2019
7. P1493Impact of atrial fibrillation during ST-elevation myocardial infarction on infarct characteristics and prognosis
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S Reinstadler, T Stiermaier, C Eitel, G Fuernau, M Saad, J Poess, S De Waha, S Desch, B Metzler, H Thiele, and I Eitel
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medicine.medical_specialty ,St elevation myocardial infarction ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Atrial fibrillation ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2018
8. [Acute myocardial infarction in patients with ST-segment elevation myocardial infarction : ESC guidelines 2017]
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H, Thiele, S, Desch, and S, de Waha
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Electrocardiography ,Outcome and Process Assessment, Health Care ,Percutaneous Coronary Intervention ,Coronary Thrombosis ,Bundle-Branch Block ,Cardiac Pacing, Artificial ,Shock, Cardiogenic ,Humans ,ST Elevation Myocardial Infarction ,Drug-Eluting Stents ,Combined Modality Therapy - Abstract
This article gives an update on the management of acute ST-segment elevation myocardial infarction (STEMI) according to the recently released European Society of Cardiology guidelines 2017 and the modifications are compared to the previous STEMI guidelines from 2012. Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion strategy. New guideline recommendations relate to the access site with a clear preference for the radial artery, use of drug-eluting stents over bare metal stents, complete revascularization during the index hospitalization, and avoidance of routine thrombus aspiration. For periprocedural anticoagulation during PCI, bivalirudin has been downgraded. Oxygen treatment should be administered only if oxygen saturation is90%. In cardiogenic shock, intra-aortic balloon pumps should no longer be used. New recommendations are in place with respect to the duration of dual antiplatelet therapy for patients without bleeding events during the first 12 months. Newly introduced sections cover myocardial infarction with no relevant stenosis of the coronary arteries (MINOCA), the introduction of new indicators for quality of care for myocardial infarction networks and new definitions for the time to reperfusion.
- Published
- 2017
9. [Prognostic importance of bystander efforts in out-of-hospital cardiac arrest]
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S, de Waha, S, Desch, I, Eitel, J-T, Gräsner, B, Jakisch, and H, Thiele
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Emergency Medical Services ,Electric Countershock ,Humans ,Prognosis ,Cardiopulmonary Resuscitation ,Out-of-Hospital Cardiac Arrest - Published
- 2017
10. RSD Effective in Some Patients with Mildly Elevated BP
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B. Hoyle and S. Desch
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medicine.medical_specialty ,Endocrinology ,Elevated bp ,Internal medicine ,medicine - Published
- 2014
11. Erotic dreams and their relationship to waking-life sexuality
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Michael Schredl, S. Desch, A. Spachmann, and F. Röming
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Psychoanalysis ,media_common.quotation_subject ,Obstetrics and Gynecology ,Human sexuality ,humanities ,Developmental psychology ,Sexual behavior ,Psychology (miscellaneous) ,Fantasy ,Dream ,Content (Freudian dream analysis) ,Psychology ,psychological phenomena and processes ,media_common - Abstract
Summary Sexual dreams are quite common and many studies indicate that men report erotic dreams more often than women. A systematic exploration as to whether the frequency of erotic dreams is related to sexual behavior or fantasy in waking life – as would be predicted by the continuity hypothesis of dreaming – has not yet been carried out. Overall, 70 students completed a questionnaire about waking life behavior and dream content. The findings indicate that the frequency of erotic dreams is related to the amount of time spent with sexual fantasies in waking life but not to intercourse or masturbation. Again, men reported more erotic dreams than women, but this is not explained solely by a higher amount of time spent with sexual activities in waking life. Whether retrospective measurements are more valid for assessing the frequency of erotic dreams in comparison with dream content analytic approaches should be studied in the future.
- Published
- 2009
12. [Timing of invasive treatment in NSTEMI: as fast as in STEMI?]
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A, Jobs, I, Eitel, and S, Desch
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Internationality ,Percutaneous Coronary Intervention ,Quality Assurance, Health Care ,Outcome Assessment, Health Care ,Practice Guidelines as Topic ,Myocardial Infarction ,Humans ,Coronary Angiography ,Time-to-Treatment - Abstract
The optimal timing of invasive diagnosis and therapy in patients with non-ST-elevation myocardial infarction (NSTEMI) is still a matter of debate. The European Society of Cardiology recommends invasive diagnosis evaluation and revascularization for practically all patients with NSTEMI within 72 h. High risk and very high risk patients should be evaluated invasively with coronary angiography within 24 h or 2 h, respectively. The risk of the individual patient should be stratified by means of the Global Registry of Acute Coronary Events (GRACE) risk score. The recommendations and guidelines are based on the results of several randomized, controlled trials and are in accordance with other retrospective studies. However, observational studies indicate that in real life many high risk patients are not evaluated invasively by coronary angiography as timely as recommended.
- Published
- 2014
13. Evaluation von T1 und T2 Mapping beim akuten Koronarsyndrom
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M Gutberlet, Matthias Grothoff, S Desch, Christian Lücke, Ingo Eitel, Holger Thiele, and T Hermeling
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Radiology, Nuclear Medicine and imaging - Published
- 2014
14. Reperfusion strategies in ST-segment elevation myocardial infarction
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T, Stiermaier, S, Desch, G, Schuler, H, Thiele, and I, Eitel
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Clinical Trials as Topic ,Myocardial Infarction ,Anticoagulants ,Myocardial Reperfusion ,Combined Modality Therapy ,Treatment Outcome ,Fibrinolytic Agents ,Practice Guidelines as Topic ,Myocardial Revascularization ,Humans ,Stents ,Thrombolytic Therapy ,Angioplasty, Balloon, Coronary ,Platelet Aggregation Inhibitors - Abstract
ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality worldwide. Emergent reperfusion of the infarct related artery is the cornerstone of STEMI treatment in order to salvage myocardium and improve cardiovascular outcome. Basically, reperfusion strategies include fibrinolysis, primary percutaneous coronary intervention (PCI) or the combination of both methods. Clinical studies indicate that primary PCI is superior to fibrinolytic therapy when performed rapidly at experienced centers. However, physicians are often faced with the decision to either accept PCI-related delays due to transfer or to administer fibrinolysis immediately. A well structured regional system of STEMI care helps to select the appropriate reperfusion strategy and guarantee timely restoration of coronary blood flow. This article reviews the evidence behind the respective reperfusion therapies and summarizes current guidelines for STEMI management.
- Published
- 2013
15. [Diagnosis and therapy of chronic myocardial ischemia. Role of cardiac magnetic resonance imaging]
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S, de Waha, I, Eitel, S, Desch, G, Fuernau, P, Lurz, G, Schuler, and H, Thiele
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Chronic Disease ,Myocardial Ischemia ,Myocardial Revascularization ,Humans ,Coronary Artery Disease ,Image Enhancement ,Prognosis ,Magnetic Resonance Angiography - Abstract
In patients with chronic coronary artery disease different therapeutic strategies, such as optimal medical therapy, revascularization by percutaneous coronary intervention or coronary artery bypass grafting have been shown to improve the prognosis and symptoms and yield proven superiority over other treatment strategies in different patient populations. Thus, individual assessment of cardiac function and structure is of paramount importance to choose the optimal therapeutic strategy and subsequently improve patient prognosis. In this setting cardiac magnetic resonance imaging (CMR) has been shown to provide important diagnostic information. Myocardial ischemia can be detected by either perfusion stress CMR demonstrating perfusion deficits indicative of hemodynamically relevant coronary artery stenosis or dobutamin stress CMR for objectifying wall motion abnormalities during stress. Both techniques are superior to single photon emission computerized tomography and stress echocardiography in specific patient populations. Myocardial viability can be assessed by means of end-diastolic wall thickness or delayed enhancement imaging which allows quantification of the transmural extent of scarring. Furthermore, low-dose dobutamin stress CMR can detect a contractile reserve. Delayed enhancement imaging leads to accurate results due to its high resolution, can be performed at rest requiring no stress within a short time period and is easy to analyze. Thus this technique can be recommended as the favored technique to assess myocardial viability. In the following article the CMR techniques for ischemia and viability testing will be presented and their role in diagnosis and therapy of chronic myocardial ischemia will be discussed.
- Published
- 2013
16. Trait-anger, hostility, and the risk of incident type 2 diabetes and diabetes-related complications: a systematic review of longitudinal studies
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M. Mohseni, N. Lindekilde, G. Forget, R. Burns, N. Schmitz, F. Pouwer, and S. Deschenes
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hostility ,diabetes ,systematic review ,Anger ,Psychiatry ,RC435-571 - Abstract
Introduction There is a well-established association between anger, hostility, and an increased risk of cardiovascular disease. Emerging evidence also suggests associations between anger/hostility and type 2 diabetes (T2D), though evidence from longitudinal studies has not yet been synthesized. Objectives To systematically review findings from existing prospective cohort studies on trait anger/hostility and the risk of T2D and diabetes-related complications. Methods Electronic searches of MEDLINE (PubMed), PsychINFO, Web of Science, and CINAHL were performed for articles/abstracts published up to December 15, 2020. Peer-reviewed longitudinal studies conducted with adult samples, with effect estimates reported for trait anger or hostility and incident T2D or diabetes-related complications, were eligible for inclusion. Risk of bias/study quality was assessed. The review protocol was published a priori in PROSPERO (CRD42020216356) and was in keeping with PRISMA guidelines. Screening for eligibility, data extraction, and quality assessment was conducted by two independent reviewers. Results Four studies with a total of 155,146 participants met the inclusion criteria. A narrative synthesis of extracted data was conducted according to the Synthesis Without Meta-Analysis guidelines. While results were mixed, our synthesis suggested a positive association between high trait-anger/hostility and increased risk of incident T2D. No longitudinal studies were identified relating to anger/hostility and incident diabetes-related complications. Geographical locations of the study samples were limited to the USA and Japan. Conclusions Further research is needed to investigate whether trait-anger/hostility predicts incident type 2 diabetes after adjustments for potential confounding factors. Longitudinal studies are needed to investigate trait-anger/hostility and the risk of diabetes-related vascular complications. Disclosure No significant relationships.
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- 2022
- Full Text
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17. Symptoms of diabetes distress, depression, and anxiety in people with type 2 diabetes: identifying central and bridge symptoms using network analysis
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A. Mcinerney, N. Lindekilde, A. Nouwen, N. Schmitz, and S. Deschenes
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Network Analysis ,comorbidity ,diabetes ,diabetes-distress ,Psychiatry ,RC435-571 - Abstract
Introduction People with diabetes are vulnerable to diabetes-related distress and are more likely to experience depressive and anxiety symptoms than the general population. Diabetes distress, depressive, and anxiety symptoms also tend to commonly co-occur. Objectives This study aimed to apply network analysis to explore the associations between diabetes distress, depressive, and anxiety symptoms in a cohort of adults with type 2 diabetes. Methods Data were from the baseline (2011) assessment of the Evaluation of Diabetes Insulin Treatment (EDIT) study (N = 1,796; 49% female; mean age = 60, SD = 8) from Quebec, Canada. A first network using the 17 items of the diabetes distress scale (DDS-17) was estimated. A second network was estimated using the 17 items of the DDS-17, the 9 depressive items of the PHQ-9, and the 7 anxiety items of the GAD-7. Symptom centrality, network stability, and bridge symptoms were examined. Results Regimen-related and physician-related distress symptoms were amongst the most central (highly connected) in the diabetes distress network. Worrying too much (anxiety), Not feeling motivated to keep up diabetes self-management (diabetes distress), and Feeling like a failure (depression) were the most central symptoms in the combined network. Feeling like a failure (depression) was highly connected to diabetes distress symptoms, representing a potential bridge between diabetes distress and depression. Conclusions Identifying central and bridge symptoms may provide new insights into diabetes distress, depressive, and anxiety symptom maintenance and comorbidity in people with type 2 diabetes. Disclosure No significant relationships.
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- 2022
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18. An investigation of depression and inflammation as potential mediators linking adverse childhood experiences with cognitive decline in adulthood: results from a prospective cohort study
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E. Lowry, A. Mc Inerney, N. Schmitz, and S. Deschenes
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adverse childhood experiences ,inflammation ,Depression ,cognitive decline ,Psychiatry ,RC435-571 - Abstract
Introduction Adverse childhood experiences (ACEs) have been associated with numerous health consequences in adulthood including cognitive decline. However, the underlying mechanisms implicated remain unclear. Objectives In this study, depressive symptoms and systemic inflammation were investigated as potential independent mediators of the association between ACEs and cognitive decline. Methods Participants were adults aged 50+ from the English Longitudinal Study of Ageing (N = 3,029; 54.8% female). Measures included self-reported ACEs at wave 3 (2006-2007), C-reactive protein (CRP) and depressive symptoms at wave 4 (2008-2009), and cognitive function at waves 3 and 7 (2014-2015). Mediation analyses examined the direct associations between ACEs and cognitive function at wave 7 and the indirect associations via depressive symptoms and CRP at wave 4 and were conducted using ordinary least squares regression models with the SPSS PROCESS macro. In Step 1, models were adjusted for sociodemographic factors and baseline cognitive function. Models in Step 2 were additionally adjusted for obesity and health behaviours (n = 1,874). Results Cumulative ACEs exposure was shown to positively predict later-life depressive symptoms, which in turn predicted cognitive decline. ACEs were also shown to positively predict systemic inflammation as measured by CRP. However, CRP did not mediate the association between ACEs and cognitive decline. Conclusions These findings suggest that ACEs are related to cognitive decline partly via depressive symptoms and corroborate prior research linking ACEs with adult systemic inflammation. Efforts towards screening for, preventing, and mitigating the effects of ACEs may therefore represent an important avenue for improving health outcomes in later life. Disclosure No significant relationships.
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- 2022
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19. [Stent implantation or bypass? Current database in patients with stable coronary heart disease]
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S, Desch, G, Schuler, and J, Niebauer
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Treatment Outcome ,Recurrence ,Humans ,Coronary Disease ,Stents ,Coronary Artery Bypass ,Prognosis ,Angioplasty, Balloon - Published
- 2005
20. Efavirenz plasma levels for the prediction of treatment failure in heavily pretreated HIV-1 infected patients
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P, Langmann, B, Weissbrich, S, Desch, T, Väth, D, Schirmer, M, Zilly, and H, Klinker
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Cyclopropanes ,Anti-HIV Agents ,Alkynes ,Drug Resistance, Viral ,Oxazines ,HIV-1 ,Humans ,Reverse Transcriptase Inhibitors ,HIV Infections ,Treatment Failure ,Prognosis ,Benzoxazines - Abstract
Efavirenz (EFV) plasma levels have been discussed as a predictor of treatment failure in HIV infected patients. The aim of this prospective, open-labeled, case-control study was to evaluate pretreated patients in regards to efavirenz plasma levels and efficacy of therapy.Blood samples were obtained monthly from 33 patients receiving efavirenz in combination with other antiretroviral agents for at least 3 months. EFV plasma concentrations and potease inhibitor (PI) plasma levels were measured by high-performance liquid chromatography (HPLC). EFV plasma levels were correlated with efficacy. In patients with virologic failure genotypic resistance testing was performed.Mean efavirenz plasma levels (n = 240) of 33 patients were 3.119 +/- 2.497 ng/ml. There were no significant differences between median efavirenz plasma levels of 24 patients (72%) with a HIV-RNA20 copies/ml (2.168 ng/ml), 3 patients with HIV-RNA of 20 500 copies/ml (3.362 ng/ml), and 6 patients with a virologic failure (500 copies/ml) (2.190 ng/ml) respectively. Efavirenz plasma levels below 1.000 ng/ml were found in 4/27 effective treated patients, and in 4/6 patients with virologic failure. In all patients with virologic failure multiple NRTI, NNRTI and PI mutations were found in genotypic resistance testing.An individual EFV plasma level below 1.000 ng/ml in one single measurement seems to be predictive of viral failure and the developement of genotypic resistance. Therapeutic drug monitoring of EFV might be helpful, especially in heavily pretreated patients, to reach long term sufficently effectiveness of therapy.
- Published
- 2002
21. Triple antiviral re-therapy for chronic hepatitis C with interferon-alpha, ribavirin and amantadine in nonresponders to interferon-alpha and ribavirin
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M, Zilly, C, Lingenauber, S, Desch, T, Väth, H, Klinker, and P, Langmann
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Adult ,Male ,Interferon-alpha ,Hepatitis C, Chronic ,Interferon alpha-2 ,Middle Aged ,Antiviral Agents ,Recombinant Proteins ,Drug Resistance, Viral ,Ribavirin ,Amantadine ,Humans ,Female ,Prospective Studies ,Safety ,Aged - Abstract
Therapy options for patients with chronic hepatitis C who failed prior treatment are needed. In recent studies triple antiviral therapy with Interferon-alpha, ribavirin, and amantadine seemed to increase sustained virological response rates in this group.To evaluate efficacy, side effects and safety of a triple re-therapy in an open labeled prospective study, we compared 23 nonresponders to interferon monotherapy (9 nonresponders, 3 relapsers, 11 with breakthrough) with 23 nonresponders to standard combination therapy (interferon plus ribavirin) (16 nonresponders, 7 breakthroughs). All outpatients enrolled for re-therapy received interferon-alpha 2a (6 mega units [MU] three times in week), ribavirin (1000-1200 mg daily in divided doses) and amantadine (200 mg daily) for six months. In case of virological re-therapy response (negative qualitative HCV RNA) study medication was continued with interferon monotherapy for another six months.Sustained virological response was achieved in 16 (35%) out of 46 prior therapy nonresponders. Response rates were dependent on pretreatment outcome. In the standard combination therapy group only 1 (6%) primary nonresponder achieved sustained response, but none of the 9 monotherapy nonresponders did. After primary breakthrough sustained response was seen in 8 of 11 (73%) patients in the interferon monotherapy and in 5 of 7 (71%) in the combination therapy group. Of 3 monotherapy relapsers 2 (66%) did also clear the virus sustained. Safety profile under triple therapy was similar to the previous therapy. Compliance was higher and side effects lower in those patients already experienced in combination therapy.In patients with a breakthrough or relapse after interferon monotherapy or standard combination therapy with interferon and ribavirin a re-therapy with a triple combination of interferon, ribavirin, and amantadine results in a high rate of sustained virological response.
- Published
- 2002
22. Efficacy and safety of an initial daily dosing regimen of interferon-alpha-2a in treatment-naive patients with chronic hepatitis C and HCV genotype 1
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S, Desch, T, Vaeth, M, Tamba, H, Klinker, and P, Langmann
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Adult ,Male ,Genotype ,Interferon-alpha ,Hepacivirus ,Hepatitis C, Chronic ,Interferon alpha-2 ,Middle Aged ,Recombinant Proteins ,Humans ,RNA, Viral ,Female ,Prospective Studies ,Safety - Abstract
Between January 1996 and February 1999 we treated two groups of patients with chronic hepatitis C and HCV genotype 1 according to different treatment regimens. 29 patients in group were treated in a prospective, open trial and received an initial dose of 6 MU Interferon-alpha-2a daily. In case of virologic response within the first 12 weeks of treatment a dosage reduction to 6 MU three times weekly was performed until the end of week 12 and 3 MU three times weekly thereafter until the completion of month 12. 35 patients in group 2 received 5 MU (Interferon-alpha-2b) or 6 MU (Interferon-alpha-2a) three times a week. If serum HCV RNA was negative after three months of treatment patients received 3 MU thrice weekly until completion of month 12. This regimen was considered standard therapy at the time of treatment. In both groups therapy was stopped in patients in whom HCV RNA remained detectable after 12 weeks of treatment or in patients who underwent virological breakthrough. The end point was a sustained virologic response defined as the absence of serum HCV RNA 6 months after treatment was completed. Primary response rates as defined by negative serum HCV RNA within the first 12 weeks of treatment were 59% in group 1 and 17% in group 2. Sustained response rates were 10% in group 1 and 3% in group 2. Initial daily dosing as in group 1 was therefore not associated with a higher sustained response rate compared to standard therapy. The safety profile was in accordance with the known side effects of interferon-alpha and was comparable in both treatment groups.
- Published
- 2001
23. S640 CLASSICALLY CONDITIONED HYPERALGESIA - LEARNING A NOCEBO RESPONSE WITHOUT VERBAL SUGGESTION
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Anne-Kathrin Bräscher, S. Desch, Dieter Kleinböhl, Susanne Becker, and Rupert Hölzl
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Anesthesiology and Pain Medicine ,Nocebo ,Hyperalgesia ,medicine ,medicine.symptom ,Psychology ,Cognitive psychology - Published
- 2011
24. [Thrombus aspiration in patients with acute myocardial infarction : Scientific evidence and guideline recommendations]
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T, Stiermaier, S, de Waha, G, Fürnau, I, Eitel, H, Thiele, and S, Desch
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Evidence-Based Medicine ,Myocardial Infarction ,Thrombosis ,Comorbidity ,Suction ,Combined Modality Therapy ,Survival Rate ,Percutaneous Coronary Intervention ,Treatment Outcome ,Risk Factors ,Practice Guidelines as Topic ,Prevalence ,Humans ,Thrombectomy - Abstract
Recent advances in percutaneous coronary intervention and antiplatelet therapy as well as faster door-to-balloon times have markedly improved the therapy of patients with acute myocardial infarction. However, impaired myocardial perfusion despite revascularization of the infarcted vessel remains an ongoing problem with high prognostic relevance. In initial clinical trials thrombus aspiration in addition to conventional percutaneous coronary intervention demonstrated benefits regarding coronary flow and myocardial perfusion and was therefore recommended in practice guidelines. These improvements in surrogate endpoints did not translate into a favorable clinical outcome in recent large-scale multicenter randomized trials investigating the routine use of thrombus aspiration in patients with acute myocardial infarction. Furthermore, an increased risk of stroke after thrombus aspiration raises safety concerns. Therefore, thrombus aspiration has been downgraded in the recent guideline updates. The current article reviews the evidence from clinical trials and the recommendations in practice guidelines regarding thrombus aspiration in acute myocardial infarction.
25. Note - Un règlement européen relatif à la gestion des espèces exotiques envahissantes : grands axes d'actions et points de débats
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N. LE-BOTLAN and S. DESCHAMPS
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invasion biologique ,espèce exotique ,règlementation ,union européenne ,Environmental technology. Sanitary engineering ,TD1-1066 ,Environmental sciences ,GE1-350 - Abstract
Une proposition de règlement « relatif à la prévention et à la gestion de l'introduction et de la propagation des espèces exotiques envahissantes » est parue le 9 septembre 2013 et a été discutée au niveau du Conseil et du Parlement européens. Dans cet article, il s'agit d'une part de présenter le règlement. Celui-ci a pour objectif de réduire les impacts des espèces exotiques envahissantes, d'harmoniser la gestion de ces espèces à l'échelle de l'Union et de développer la prévention. Les dispositions réglementaires qu'il contient s'appliqueront à une liste d'espèces exotiques envahissantes préoccupantes pour l'Union et impliqueront une série d'interdictions, une gestion des voies d'introduction, un système de surveillance, des contrôles aux frontières de l'Union, des mesures de réaction rapide ainsi qu'une gestion des espèces largement répandues. D'autre part, nous présenterons les points qui ont fait débat durant les mois précédents, comme la nature de l'impact des espèces de la liste, les territoires concernés par ces espèces et sur lesquels les dispositions devront s'appliquer (tout ou partie du territoire de l'Union), les interdictions et les dérogations. Cette présentation permet d'apprécier l'importance et la complexité de la politique nationale à mettre en œuvre.
- Published
- 2014
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26. Un règlement européen relatif à la gestion des espèces exotiques envahissantes : grands axes d'actions et points de débats
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N. LE-BOTLAN and S. DESCHAMPS
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Environmental technology. Sanitary engineering ,TD1-1066 ,Environmental sciences ,GE1-350 - Abstract
Face aux enjeux environnementaux et économiques représentés par les invasions biologiques, les instances européennes ont proposé un règlement aux États membres afin de coordonner leurs efforts pour développer la prévention et réduire les impacts de ces espèces à l'échelle de l'Union. Focus sur les principales orientations d'action et les points de débats.
- Published
- 2014
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27. Prognostic Impact of Admission Time in Infarct-Related Cardiogenic Shock: An ECLS-SHOCK Substudy.
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Schupp T, Thiele H, Rassaf T, Abbas Mahabadi A, Lehmann R, Eitel I, Skurk C, Clemmensen P, Hennersdorf M, Voigt I, Linke A, Tigges E, Nordbeck P, Jung C, Lauten P, Feistritzer HJ, Pöss J, Ouarrak T, Schneider S, Behnes M, Duerschmied D, Desch S, Freund A, Zeymer U, and Akin I
- Subjects
- Humans, Male, Female, Middle Aged, Time Factors, Aged, Treatment Outcome, Risk Factors, Risk Assessment, Time-to-Treatment, Myocardial Infarction mortality, Myocardial Infarction therapy, Myocardial Infarction diagnosis, Myocardial Infarction complications, After-Hours Care, Shock, Cardiogenic mortality, Shock, Cardiogenic therapy, Shock, Cardiogenic diagnosis, Shock, Cardiogenic etiology, Shock, Cardiogenic physiopathology, Extracorporeal Membrane Oxygenation mortality, Extracorporeal Membrane Oxygenation adverse effects, Patient Admission
- Abstract
Background: The outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and the efficacy and safety of extracorporeal life support (ECLS) may be affected by the timing of hospital admission., Objectives: The present ECLS-SHOCK substudy sought to investigate the prognostic impact of on-hours vs off-hours admission and the efficacy of ELCS according to the timing of hospital admission time in AMI-CS., Methods: Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial from 2019 to 2022 were included. The prognosis of patients admitted during regular hours (ie, on-hours) was compared to patients admitted during off-hours. Thereafter, the prognostic impact of ECLS was investigated stratified by the timing of hospital admission. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier, univariable, and multivariable logistic regression analyses., Results: Of 417 patients enrolled in the ECLS-SHOCK trial, 48.4% (n = 202) were admitted during off-hours. Patients admitted during off-hours were younger (median age = 62 years [Q1-Q3: 55-69 years] vs 63 years [Q1-Q3: 58-71 years]; P = 0.036) and more commonly treated using initial femoral access for coronary angiography (79.0% [n = 158/200] vs 67.9% [n = 146/215]; P = 0.011). However, off-hours admission was not associated with an increased risk of 30-day all-cause mortality (off-hours vs on-hours: 46.0% [n = 93/202] vs 50.7% [n = 109/215]; OR: 0.83; 95% CI: 0.56-1.22). Furthermore, ECLS had no prognostic impact on 30-day all-cause mortality in patients with AMI-CS admitted during on-hours (50.5% [n = 52/103] vs 50.9% [n = 57/112]; P = 0.95; OR: 0.98; 95% CI: 0.58-1.68) or in patients admitted during off-hours (45.3% [n = 48/106] vs 46.9% [n = 45/96]; P = 0.82; OR: 0.94; 95% CI: 0.54-1.63). Finally, ECLS was associated with an increased risk of bleeding events, especially in patients admitted during on-hours., Conclusions: The prognosis in AMI-CS was not affected by admission time with a similar effect of ECLS during on- and off-hours., Competing Interests: Funding Support and Author Disclosure Supported by the Else Kröner Fresenius Foundation, the German Heart Research Foundation, and the Helios Health Institute (formerly Leipzig Heart Institute). Dr Rassaf has received honoraria, lecture fees, and grant support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie, Daiicho-Sankyo, Boehringer Ingelheim, Novo Nordisk, Cardiac Dimensions, and Pfizer, all unrelated to this work; and is a cofounder of Bimyo GmbH, a company that develops cardioprotective peptides. Dr Clemmensen has previously or currently been involved in research contracts, consulting, and Speakers Bureau for Abbott, Abiomed, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CeleCor, CytoSorbent, Daiichi-Sankyo, Eli-Lilly, Evolva, Ferrer, Fibrex, Idorsia, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, and ViFor Pharma; and has received research and/or educational grants from Abbott, Abiomed, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CeleCor, CytoSorbent, Daiichi-Sankyo, Eli-Lilly, Evolva, Ferrer, Fibrex, Idorsia, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, and ViFor Pharma. Dr Linke has received grants from Novartis and Edwards Lifesciences; has received personal fees from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Edwards Lifesciences, Medtronic, Meril, Novartis, Sanofi Genzyme, and Pfizer; and has received other fees from Picardia, Filterlex, and Transverse Medical outside the submitted work. Dr Pöss has received research grants (institutional) from German Cardiac Society, German Heart Research Foundation, Dr Rolf M. Schwiete Foundation, and Maquet Cardiopulmonary GmbH. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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28. Routine extracorporeal life support in infarct-related cardiogenic shock: 1-year results of the ECLS-SHOCK trial.
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Desch S, Zeymer U, Akin I, Behnes M, Duerschmied D, Rassaf T, Mahabadi AA, Lehmann R, Eitel I, Graf T, Seidler T, Schuster A, Thevathasan T, Skurk C, Clemmensen P, Hennersdorf M, Fichtlscherer S, Voigt I, Seyfarth M, John S, Ewen S, Linke A, Tigges E, Nordbeck P, Bruch L, Jung C, Franz J, Lauten P, Noc M, Fuernau G, Feistritzer HJ, Pöss J, Kirchhof E, Ouarrak T, Schneider S, Freund A, and Thiele H
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- Humans, Male, Female, Middle Aged, Treatment Outcome, Shock, Cardiogenic therapy, Extracorporeal Membrane Oxygenation methods, Myocardial Infarction complications, Myocardial Infarction therapy
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- 2024
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29. Do DanGer-SHOCK-like patients benefit from VA-ECMO treatment in infarct-related cardiogenic shock? results of an individual patient data meta-analysis.
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Zeymer U, Freund A, Hochadel M, Ostadal P, Belohlavek J, Massberg S, Brunner S, Flather M, Adlam D, Hassager C, Moeller JE, Schneider S, Desch S, and Thiele H
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- Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Extracorporeal Membrane Oxygenation methods, Myocardial Infarction complications, Myocardial Infarction therapy, Myocardial Infarction mortality, Shock, Cardiogenic therapy, Shock, Cardiogenic mortality, Shock, Cardiogenic etiology
- Abstract
Aims: In a recent meta-analysis of randomized controlled trials, routine use of veno-arterial ECMO (VA-ECMO) did not improve outcomes in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), while a microaxial flow pump reduced mortality in a selected group of patients with AMI-CS in the DanGer-Shock trial., Methods and Results: Individual patient data of patients included in four randomized clinical trials investigating the routine use of VA-ECMO in AMI-CS were centrally analysed. For the purpose of this sub-analysis, DanGer-Shock-like patients were analysed (STEMI only, presumed low likelihood of brain injury). The primary endpoint was 180-day all-cause mortality. A total of 202 patients (106 randomized to VA-ECMO and 96 to control) were included. There were no differences in baseline characteristics, angiographic and interventional features between the two groups. Mortality after 6 months was numerically lower with VA-ECMO between the groups [45% in VA-ECMO group vs. 51% in control group; hazard ratio, 0.84; 95% confidence interval (CI), 0.56-1.26], while major bleeding (OR, 2.24; 95% CI, 1.08-4.64) and peripheral vascular complications (OR, 3.65; 95% CI, 1.15-11.56) were increased with the use of VA-ECMO., Conclusion: In this exploratory subgroup analysis in patients with CS, STEMI, and a low likelihood of brain injury, there was no mortality benefit with the routine use of VA-ECMO. However, as indicated by the large confidence intervals, the statistical power was limited to draw definite conclusions., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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30. Temporary mechanical circulatory support in infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials with 6-month follow-up.
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Thiele H, Møller JE, Henriques JPS, Bogerd M, Seyfarth M, Burkhoff D, Ostadal P, Rokyta R, Belohlavek J, Massberg S, Flather M, Hochadel M, Schneider S, Desch S, Freund A, Eiskjær H, Mangner N, Pöss J, Polzin A, Schulze PC, Skurk C, Zeymer U, and Hassager C
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- Aged, Female, Humans, Male, Middle Aged, Follow-Up Studies, Randomized Controlled Trials as Topic, Treatment Outcome, Extracorporeal Membrane Oxygenation methods, Heart-Assist Devices, Myocardial Infarction mortality, Myocardial Infarction complications, Shock, Cardiogenic therapy, Shock, Cardiogenic mortality, Shock, Cardiogenic etiology
- Abstract
Background: Percutaneous active mechanical circulatory support (MCS) devices are being increasingly used in the treatment of acute myocardial infarction-related cardiogenic shock (AMICS) despite conflicting evidence regarding their effect on mortality. We aimed to ascertain the effect of early routine active percutaneous MCS versus control treatment on 6-month all-cause mortality in patients with AMICS., Methods: In this individual patient data meta-analysis, randomised controlled trials of potential interest were identified, without language restriction, by querying the electronic databases MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, and Embase, as well as ClinicalTrials.gov, up to Jan 26, 2024. All randomised trials with 6-month mortality data comparing early routine active MCS (directly in the catheterisation laboratory after randomisation) versus control in patients with AMICS were included. The primary outcome was 6-month all-cause mortality in patients with AMICS treated with early routine active percutaneous MCS versus control, with a focus on device type (loading, such as venoarterial extracorporeal membrane oxygenation [VA-ECMO] vs unloading) and patient selection. Hazard ratios (HRs) of the primary outcome measure were calculated using Cox regression models. This study is registered with PROSPERO, CRD42024504295., Findings: Nine reports of randomised controlled trials (n=1114 patients) were evaluated in detail. Overall, four randomised controlled trials (n=611 patients) compared VA-ECMO with a control treatment and five randomised controlled trials (n=503 patients) compared left ventricular unloading devices with a control treatment. Two randomised controlled trials also included patients who did not have AMICS, who were excluded (55 patients [44 who were treated with VA-ECMO and 11 who were treated with a left ventricular unloading device]). The median patient age was 65 years (IQR 57-73); 845 (79·9%) of 1058 patients with data were male and 213 (20·1%) were female. No significant benefit of early unselected MCS use on 6-month mortality was noted (HR 0·87 [95% CI 0·74-1·03]; p=0·10). No significant differences were observed for left ventricular unloading devices versus control (0·80 [0·62-1·02]; p=0·075), and loading devices also had no effect on mortality (0·93 [0·75-1·17]; p=0·55). Patients with ST-elevation cardiogenic shock without risk of hypoxic brain injury had a reduction in mortality with MCS use (0·77 [0·61-0·97]; p=0·024). Major bleeding (odds ratio 2·64 [95% CI 1·91-3·65]) and vascular complications (4·43 [2·37-8·26]) were more frequent with MCS use than with control., Interpretation: The use of active MCS devices in patients with AMICS did not reduce 6-month mortality (regardless of the device used) and increased major bleeding and vascular complications. However, patients with ST-elevation cardiogenic shock without risk of hypoxic brain injury had a reduction in mortality after MCS use. Therefore, the use of MCS should be restricted to certain patients only., Funding: The Heart Center Leipzig at Leipzig University and the Foundation Institut für Herzinfarktforschung., Competing Interests: Declaration of interests HT is the current president of the German Cardiac Society. JEM reports lecture fees from Abbott and Boehringer Ingelheim; institutional research grants from Abiomed and Novo Nordisk Foundation; travel support from Abiomed; equipment from Abiomed; and served as a data and safety monitoring board member for DanHeart. JB reports speaker fees from Resuscitec and Getinge. DB reports payment for travel expenses from Abiomed; and institutional support for steering committee membership. MF reports grants paid to their institution from the European Commission. HE reports speaker fees from Novartis; and travel expenses from Abbott paid to their institution. PO reports speaker fees from Getinge, Abiomed, Fresenius, Edwards Lifesciences, and AOP; and is the president of the Czech Society of Cardiology. PCS reports lecture fees from Abiomed and Abbott; and institutional research support from Abiomed. JP reports institutional research grants from the German Cardiac Society, Schwiete Foundation, German Heart Research Foundation, and Maquet. CH reports lecture fees from Abiomed. MH reports research support paid to their institution from the Heart Center Leipzig. AP reports lecture fees and institutional research grants from Abiomed. NM reports lecture fees from Abbott, Abiomed, AstraZeneca, B Braun, Biotronik, the British Society of Cardiovascular Imaging, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Novartis, Pfizer, and Sanofi Genzyme; grants paid to their institution from Abiomed; and unrestricted educational grants from Abiomed and BSCI. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)
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31. A Bayesian Reanalysis of the CULPRIT-SHOCK Trial.
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Jung C, Wernly B, Masyuk M, Kelm M, Freund A, Pöss J, Desch S, Schneider S, Akin I, Schlesinger S, Schrage B, Zeymer U, and Thiele H
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Background: The optimal revascularization strategy for patients with acute myocardial infarction (AMI), cardiogenic shock (CS), and multivessel disease remains controversial. The CULPRIT-SHOCK trial compared culprit-lesion-only versus immediate multivessel percutaneous coronary intervention (PCI), providing important data but leaving efficacy questions unresolved. To address lingering uncertainties and gain deeper insights, we performed a Bayesian reanalysis of the CULPRIT-SHOCK trial data., Methods: We conducted a Bayesian re-analysis of the CULPRIT-SHOCK trial data using non-informative, skeptical, and enthusiastic priors. Relative risks (RR) with 95% highest posterior density intervals were calculated. We defined the Minimally Clinically Important Difference (MCID) as RR <0.84. We performed subgroup analyses for key patient characteristics and assessed secondary outcomes and safety endpoints. Probabilities of benefit, achieving MCID, and harm were computed. Results are presented as median RR with probabilities of effect sizes., Results: Bayesian re-analysis showed a median relative risk of 0.82 (95% HPD: 0.66-1.04) with a non-informative prior, indicating a 95% probability of benefit and 59% probability of achieving MCID. Subgroup analyses revealed potentially stronger effects in males (RR: 0.78, 73% probability of MCID), patients without diabetes (RR: 0.76, 79% probability of MCID), and those with non-anterior STEMI (RR: 0.74, 76% probability of MCID). Secondary outcomes suggested potential benefits in mortality (RR: 0.85) and need for renal replacement therapy (RR: 0.72), but increased risks of recurrent MI (RR: 2.84) and urgent revascularization (RR: 2.88)., Conclusion: Our Bayesian reanalysis provides intuitive insights by quantifying probabilities of treatment effect sizes, offering further evidence favoring the culprit-lesion-only PCI strategy in AMI patients with cardiogenic shock and multivessel disease. The analysis demonstrates a high probability of overall benefit, with a notable chance of achieving a minimally clinically important difference, particularly in specific subgroups. These findings not only support the consideration of culprit-lesion-only PCI in certain patient populations but also underscore the need for careful risk-benefit assessment. Furthermore, our hypothesis-generating subgroup analyses, which show varying probabilities of achieving MCID, illuminate promising avenues for future targeted investigations in this critical patient population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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32. Interrater Variability of ML-Based CT-FFR in Patients without Obstructive CAD before TAVR: Influence of Image Quality, Coronary Artery Calcifications, and Location of Measurement.
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Gohmann RF, Schug A, Krieghoff C, Seitz P, Majunke N, Buske M, Kaiser F, Schaudt S, Renatus K, Desch S, Leontyev S, Noack T, Kiefer P, Pawelka K, Lücke C, Abdelhafez A, Ebel S, Borger MA, Thiele H, Panknin C, Abdel-Wahab M, Horn M, and Gutberlet M
- Abstract
Objectives : CT-derived fractional flow reserve (CT-FFR) can improve the specificity of coronary CT-angiography (cCTA) for ruling out relevant coronary artery disease (CAD) prior to transcatheter aortic valve replacement (TAVR). However, little is known about the reproducibility of CT-FFR and the influence of diffuse coronary artery calcifications or segment location. The objective was to assess the reliability of machine-learning (ML)-based CT-FFR prior to TAVR in patients without obstructive CAD and to assess the influence of image quality, coronary artery calcium score (CAC), and the location of measurement within the coronary tree. Methods : Patients assessed for TAVR, without obstructive CAD on cCTA were evaluated with ML-based CT-FFR by two observers with differing experience. Differences in absolute values and categorization into hemodynamically relevant CAD (CT-FFR ≤ 0.80) were compared. Results in regard to CAD were also compared against invasive coronary angiography. The influence of segment location, image quality, and CAC was evaluated. Results : Of the screened patients, 109/388 patients did not have obstructive CAD on cCTA and were included. The median (interquartile range) difference of CT-FFR values was -0.005 (-0.09 to 0.04) ( p = 0.47). Differences were smaller with high values. Recategorizations were more frequent in distal segments. Diagnostic accuracy of CT-FFR between both observers was comparable (proximal: Δ0.2%; distal: Δ0.5%) but was lower in distal segments (proximal: 98.9%/99.1%; distal: 81.1%/81.6%). Image quality and CAC had no clinically relevant influence on CT-FFR. Conclusions : ML-based CT-FFR evaluation of proximal segments was more reliable. Distal segments with CT-FFR values close to the given threshold were prone to recategorization, even if absolute differences between observers were minimal and independent of image quality or CAC.
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- 2024
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33. Glycoprotein IIb/IIIa Inhibitors in Acute Myocardial Infarction and Angiographic Microvascular Obstruction: The REVERSE-FLOW Trial.
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Eitel I, Saraei R, Jurczyk D, Fach A, Hambrecht R, Wienbergen H, Frerker C, Schmidt T, Allali A, Joost A, Marquetand C, Kurz T, Haaf P, Fahrni G, Mueller C, Desch S, Thiele H, and Stiermaier T
- Abstract
Background and Aims: Glycoprotein (GP) IIb/IIIa inhibitors are recommended in acute myocardial infarction (AMI) for bailout treatment in case of angiographic microvascular obstruction (MVO), also termed no-reflow phenomenon, after percutaneous coronary intervention (PCI) with, however, lacking evidence (class IIa, level C)., Methods: The investigator-initiated, international, multicenter REVERSE-FLOW trial randomized 120 patients with AMI and Thrombolysis In Myocardial Infarction flow grade ≤2 after primary PCI to optimal medical therapy with or without GP IIb/IIIa inhibitor. The primary endpoint was infarct size (%LV) assessed by cardiac magnetic resonance (CMR). Secondary endpoints included CMR-derived MVO and 30-day adverse clinical events. The trial is registered with ClinicalTrials.gov: NCT02739711., Results: The population was predominantly male (76.7%) with a median age of 66 years and ST-elevation myocardial infarction in 73.3% of patients. Clinical and angiographic characteristics were well balanced between the cohorts. Patients in the treatment group (n=62) received eptifibatide (n=41) or tirofiban (n=21). Infarct size assessed by CMR imaging was similar in both study groups (25.4% of left ventricular mass [LV] vs. 25.2%LV; p=0.386). However, the number of patients with evidence of CMR-derived MVO (74.5% vs. 92.2%; p=0.017) and the extent of MVO (2.1%LV vs. 3.4%LV; p=0.025) were significantly reduced in the GP IIb/IIIa inhibitor group compared to controls. Thirty-day outcome showed an increased bleeding risk after GP IIb/IIIa inhibitor administration restricted to non-life-threatening bleedings (22.6% vs. 6.9%; p=0.016) without differences in all-cause mortality (4.8% vs. 3.4%; p=0.703)., Conclusions: Bailout GP IIb/IIIa inhibition in AMI patients with angiographic MVO failed to reduce the primary endpoint infarct size but decreased CMR-derived MVO and led to an increase in non-fatal bleeding events., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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34. GLP-1 in patients with myocardial infarction complicated by cardiogenic shock-an IABP-SHOCK II-substudy.
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Lehrke M, Fuernau G, Jung C, Kahles F, Moellmann J, Eitel I, Thelemann N, Desch S, Werdan K, Zeymer U, Adams V, Marx N, and Thiele H
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- Humans, Male, Female, Aged, Middle Aged, Prospective Studies, Percutaneous Coronary Intervention methods, Time Factors, Prognosis, Intra-Aortic Balloon Pumping methods, Risk Factors, Follow-Up Studies, Treatment Outcome, Survival Rate trends, Shock, Cardiogenic blood, Shock, Cardiogenic mortality, Shock, Cardiogenic etiology, Glucagon-Like Peptide 1 blood, Biomarkers blood, Myocardial Infarction blood, Myocardial Infarction complications, Myocardial Infarction mortality
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Background: Glucagon-like peptide-1 (GLP-1) is a gut-derived peptide secreted in response to nutritional and inflammatory stimuli. Elevated GLP-1 levels predict adverse outcome in patients with acute myocardial infarction or sepsis. GLP-1 holds cardioprotective effects and GLP-1 receptor agonists reduce cardiovascular events in high-risk patients with diabetes. In this study, we aimed to investigate the capacity of GLP-1 to predict outcome in patients with cardiogenic shock (CS) complicating myocardial infarction., Methods: Circulating GLP-1 levels were serially assessed in 172 individuals during index PCI and day 2 in a prospectively planned biomarker substudy of the IABP-SHOCK II trial. All-cause mortality at short- (30 days), intermediate- (1 year), and long-term (6 years) follow-up was used for outcome assessment., Results: Patients with fatal short-term outcome (n = 70) exhibited higher GLP-1 levels [86 (interquartile range 45-130) pM] at ICU admission in comparison to patients with 30-day survival [48 (interquartile range 33-78) pM; p < 0.001] (n = 102). Repeated measures ANOVA revealed a significant interaction of GLP-1 dynamics from baseline to day 2 between survivors and non-survivors (p = 0.04). GLP-1 levels above vs. below the median proved to be predictive for short- [hazard ratio (HR) 2.43; 95% confidence interval (CI) 1.50-3.94; p < 0.001], intermediate- [HR 2.46; 95% CI 1.62-3.76; p < 0.001] and long-term [HR 2.12; 95% CI 1.44-3.11; p < 0.001] outcome by multivariate Cox-regression analysis., Conclusion: Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations., Trial Registration: www., Clinicaltrials: gov Identifier: NCT00491036., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
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- 2024
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35. Myocardial injury and clinical outcome in octogenarians after non-ST-elevation myocardial infarction.
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Pätz T, Stiermaier T, Meusel M, Reinhard I, Jensch PJ, Rawish E, Wang J, Feistritzer HJ, Schuster A, Koschalka A, Lange T, Kowallick JT, Desch S, Thiele H, and Eitel I
- Abstract
Introduction: The aim of this study was to analyze age-associated myocardial injury and clinical outcome after non-ST-elevation myocardial infarction (NSTEMI)., Methods: This prospective, multicenter study consists of 440 patients with NSTEMI enrolled at 7 centers. All patients were treated with primary percutaneous coronary intervention and underwent cardiac magnetic resonance (CMR) imaging 1-10 days after study inclusion. CMR parameters of myocardial injury and clinical outcome were evaluated by creating 2 subgroups: <80 years vs. ≥80 years. The clinical endpoint was the 1-year incidence of major adverse cardiac events (MACE) consisting of death, re-infarction and new congestive heart failure., Results: Elderly patients ≥80 years accounted for 13.9% of the study population and showed a divergent cardiovascular risk profile compared to the subgroup of patients <80 years. CMR imaging did not reveal significant differences regarding infarct size, microvascular obstruction, left ventricular ejection fraction or multidimensional strain analysis between the study groups. At 1-year follow-up, MACE rate was significantly increased in patients ≥80 years compared to patients aged <80 years (19.7% vs. 9.6%; p = 0.019). In a multiple stepwise logistic regression model, the number of diseased vessels, aldosterone antagonist use and left ventricular global longitudinal strain were identified as independent predictors for MACE in all patients, while there was no independent predictive value of age regarding 1-year clinical outcome., Conclusion: This prospective, multicenter analysis shows that structural and functional myocardial damage is similar in younger and older patients with NSTEMI. Furthermore, in this heterogeneous but also clinically representative cohort with reduced sample size, age was not independently associated with 1-year clinical outcome, despite an increased event rate in patients ≥80 years., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Pätz, Stiermaier, Meusel, Reinhard, Jensch, Rawish, Wang, Feistritzer, Schuster, Koschalka, Lange, Kowallick, Desch, Thiele and Eitel.)
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- 2024
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36. Why VA-ECMO should not be used routinely in AMI-cardiogenic shock.
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Thiele H, Desch S, Freund A, and Zeymer U
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- 2024
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37. Incidence and Outcomes of Emergency Intraprocedural Surgical Conversion During Transcatheter Aortic Valve Implantation: A Multicentric Analysis.
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Marin-Cuartas M, de Waha S, de la Cuesta M, Deo SV, Kaminski A, Fach A, Meyer AL, Popov AF, Hagl C, Joskowiak D, Kuhn EW, Ius F, Leuschner F, Awad G, Thiele H, Abdalla A, Garbade J, Ender J, Wehrmann K, Eghbalzadeh K, Vitanova K, Conradi L, Diab M, Franz M, Geyer M, Meineri M, Misfeld M, Abdel-Wahab M, Bhadra OD, Osteresch R, Sandoval Boburg R, Lange R, Leontyev S, Saha S, Desch S, Lehmann S, Noack T, Doenst T, Borger MA, and Kiefer P
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- Humans, Incidence, Male, Female, Conversion to Open Surgery statistics & numerical data, Aged, 80 and over, Treatment Outcome, Aged, Retrospective Studies, Emergencies, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis surgery
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- 2024
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38. Microaxial Flow Pump in Infarct-Related Cardiogenic Shock.
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Thiele H, Desch S, and Zeymer U
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- Humans, Clinical Trials as Topic, Heart-Assist Devices, Shock, Cardiogenic etiology, Shock, Cardiogenic mortality, Shock, Cardiogenic surgery, ST Elevation Myocardial Infarction complications
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- 2024
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39. German Cardiac Arrest Registry (G-CAR)-results of the pilot phase.
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Pöss J, Sinning C, Roßberg M, Hösler N, Ouarrak T, Böttiger BW, Ewen S, Wienbergen H, Voss F, Dutzmann J, Tigges E, Voigt I, Freund A, Desch S, Michels G, Thiele H, and Zeymer U
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Background: In Europe, more than 300,000 persons per year experience out-of-hospital cardiac arrest (OHCA). Despite medical progress, only few patients survive with good neurological outcome. For many issues, evidence from randomized trials is scarce. OHCA often occurs for cardiac causes. Therefore, we established the national, prospective, multicentre German Cardiac Arrest Registry (G-CAR). Herein, we describe the first results of the pilot phase., Results: Over a period of 16 months, 15 centres included 559 consecutive OHCA patients aged ≥ 18 years. The median age of the patients was 66 years (interquartile range 57;75). Layperson resuscitation was performed in 60.5% of all OHCA cases which were not observed by emergency medical services. The initial rhythm was shockable in 46.4%, and 29.1% of patients had ongoing CPR on hospital admission. Main presumed causes of OHCA were acute coronary syndromes (ACS) and/or cardiogenic shock in 54.8%, with ST-elevation myocardial infarction being the most common aetiology (34.6%). In total, 62.9% of the patients underwent coronary angiography; percutaneous coronary intervention (PCI) was performed in 61.4%. Targeted temperature management was performed in 44.5%. Overall in-hospital mortality was 70.5%, with anoxic brain damage being the main presumed cause of death (38.8%). Extracorporeal cardiopulmonary resuscitation (eCPR) was performed in 11.0%. In these patients, the in-hospital mortality rate was 85.2%., Conclusions: G-CAR is a multicentre German registry for adult OHCA patients with a focus on cardiac and interventional treatment aspects. The results of the 16-month pilot phase are shown herein. In parallel with further analyses, scaling up of G-CAR to a national level is envisaged. Trial registration ClinicalTrials.gov identifier: NCT05142124., (© 2024. The Author(s).)
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- 2024
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40. Study Group on Cardiogenic Shock and Cardiac Arrest-a global network to improve the quality of care.
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Tavazzi G, Desch S, Huber K, Poess J, Hassager C, and Price S
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- Humans, Quality Improvement, Quality of Health Care, Global Health, Shock, Cardiogenic therapy, Heart Arrest therapy
- Abstract
Competing Interests: Conflict of interest: none declared.
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- 2024
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41. Current spectrum and outcomes of infarct-related cardiogenic shock: insights from the CULPRIT-SHOCK registry and randomized controlled trial.
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Zeymer U, Heer T, Ouarrak T, Akin I, Noc M, Stepinska J, Oldroyd K, Serpytis P, Montalescot G, Huber K, Windecker S, Savonitto S, Vrints C, Schneider S, Desch S, and Thiele H
- Subjects
- Humans, Female, Male, Aged, Europe epidemiology, Middle Aged, Follow-Up Studies, Treatment Outcome, Survival Rate trends, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Registries, Myocardial Infarction complications, Percutaneous Coronary Intervention methods
- Abstract
Aims: We analysed consecutive patients with acute myocardial infarction complicated by cardiogenic shock (CS) who were enrolled into the CULPRIT-SHOCK randomized controlled trial (RCT) and those with exclusion criteria who were included into the accompanying registry., Methods and Results: In total, 1075 patients with infarct-related CS were screened for CULPRIT-SHOCK in 83 specialized centres in Europe; 369 of them had exclusion criteria for the RCT and were enrolled into the registry. Patients were followed over 1 year. The mean age was 68 years and 260 (25%) were women. 13.5%, 30.9%, and 55.6% had one-vessel, two-vessel, and three-vessel coronary artery disease (CAD), respectively. Significant left main (LM) coronary artery stenosis was present in 8.0%. 54.2% of the patients had cardiac arrest before admission. Thrombolysis in myocardial infarction (TIMI) 3 patency of the infarct vessel after percutaneous coronary intervention was achieved in 83.6% of all patients. Mechanical circulatory support was applied in one-third of patients. Total mortality after 30 days and 1 year was 47.6% and 52.9%. Mortality after 1 year was highest in patients with LM coronary artery stenosis (63.5%), followed by three-vessel (56.6%), two-vessel (49.8%), and one-vessel CAD (38.6%), respectively. Mechanical complications were rare (21/1008; 2.1%) but associated with a high mortality of 66.7% after 1 year., Conclusion: In specialized centres in Europe, short- and long-term mortality of patients with infarct-related CS treated with an invasive strategy is still high and mainly depends on the extent of CAD. Therefore, there is still a need for improvement of care to improve the prognosis of infarct-related CS., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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42. GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes.
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Jobs A, Boeddinghaus J, Neumann JT, Goßling A, Sörensen NA, Twerenbold R, Nestelberger T, Lopez-Ayala P, Gimenez MR, Miro O, Koechlin L, Buergin N, Feistritzer HJ, Collet JP, Bhatt DL, Granger CB, Blankenberg S, Desch S, Mueller C, Westermann D, and Thiele H
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- Humans, Troponin, Coronary Angiography, Risk Assessment methods, Acute Coronary Syndrome diagnosis, Myocardial Infarction diagnosis
- Abstract
Background: The GRACE risk score is generically recommended by guidelines for timing of invasive coronary angiography without stating which score should be used. The aim was to determine the diagnostic performance of different GRACE risk scores in comparison to the ESC 0/1 h-algorithm using high-sensitivity cardiac troponin (hs-cTn)., Methods: Prospectively enrolled patients presenting with symptoms suggestive of myocardial infarction (MI) in two large studies testing biomarker diagnostic strategies were included. Five GRACE risk scores were calculated. The amount of risk reclassification and the theoretical impact on guideline-recommended timing of invasive coronary angiography was studied., Results: Overall, 8,618 patients were eligible for analyses. Comparing different GRACE risk scores, up to 63.8% of participants were reclassified into a different risk category. The proportion of MIs identified (i.e., sensitivity) dramatically differed between GRACE risk scores (range 23.8-66.5%) and was lower for any score than for the ESC 0/1 h-algorithm (78.1%). Supplementing the ESC 0/1 h-algorithm with a GRACE risk score slightly increased sensitivity (P < 0.001 for all scores). However, this increased the number of false positive results., Conclusion: The substantial amount of risk reclassification causes clinically meaningful differences in the proportion of patients meeting the recommended threshold for pursuing early invasive strategy according to the different GRACE scores. The single best test to detect MIs is the ESC 0/1 h-algorithm. Combining GRACE risk scoring with hs-cTn testing slightly increases the detection of MIs but also increases the number of patients with false positive results who would undergo potential unnecessarily early invasive coronary angiography., (© 2023. The Author(s).)
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- 2024
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43. Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials.
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Hamidi F, Anwari E, Spaulding C, Hauw-Berlemont C, Vilfaillot A, Viana-Tejedor A, Kern KB, Hsu CH, Bergmark BA, Qamar A, Bhatt DL, Furtado RHM, Myhre PL, Hengstenberg C, Lang IM, Frey N, Freund A, Desch S, Thiele H, Preusch MR, and Zelniker TA
- Subjects
- Humans, Cardiopulmonary Resuscitation, Electrocardiography, Time Factors, Time-to-Treatment, Coronary Angiography methods, Out-of-Hospital Cardiac Arrest diagnostic imaging, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest therapy, Randomized Controlled Trials as Topic
- Abstract
Background: Recent randomized controlled trials did not show benefit of early/immediate coronary angiography (CAG) over a delayed/selective strategy in patients with out-of-hospital cardiac arrest (OHCA) and no ST-segment elevation. However, whether selected subgroups, specifically those with a high pretest probability of coronary artery disease may benefit from early CAG remains unclear., Methods: We included all randomized controlled trials that compared a strategy of early/immediate versus delayed/selective CAG in OHCA patients and no ST elevation and had a follow-up of at least 30 days. The primary outcome of interest was all-cause death. Odds ratios (OR) were calculated and pooled across trials. Interaction testing was used to assess for heterogeneity of treatment effects., Results: In total, 1512 patients (67 years, 26% female, 23% prior myocardial infarction) were included from 5 randomized controlled trials. Early/immediate versus delayed/selective CAG was not associated with a statistically significant difference in odds of death (OR 1.12, 95%-CI 0.91-1.38), with similar findings for the composite outcome of all-cause death or neurological deficit (OR 1.10, 95%-CI 0.89-1.36). There was no effect modification for death by age, presence of a shockable initial cardiac rhythm, history of coronary artery disease, presence of an ischemic event as the presumed cause of arrest, or time to return of spontaneous circulation (all P-interaction > 0.10). However, early/immediate CAG tended to be associated with higher odds of death in women (OR 1.52, 95%-CI 1.00-2.31, P = 0.050) than in men (OR 1.04, 95%-CI 0.82-1.33, P = 0.74; P-interaction 0.097)., Conclusion: In OHCA patients without ST-segment elevation, a strategy of early/immediate versus delayed/selective CAG did not reduce all-cause mortality across major subgroups. However, women tended to have higher odds of death with early CAG., (© 2023. The Author(s).)
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- 2024
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44. Revascularization Strategy in Myocardial Infarction with Multivessel Disease.
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Jobs A, Desch S, Freund A, Feistritzer HJ, and Thiele H
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The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated by several randomized trials and meta-analyses, leading to a strong guideline recommendation. However, similar data are lacking for ACS without ST-segment elevation (NSTE-ACS). Non-randomized data suggesting a benefit from complete revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) are prone to selection bias and should be interpreted with caution. A series of large randomized controlled trials have been initiated recently to address these open questions.
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- 2024
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45. A study of bailout plug-based closure after failed suture-based closure in patients undergoing transfemoral TAVI.
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Dumpies O, Abdelhafez A, Rotta Detto Loria J, Richter I, Feistritzer HJ, Majunke N, Desch S, Noack T, Thiele H, and Abdel-Wahab M
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- Humans, Constriction, Pathologic, Odds Ratio, Patients, Transcatheter Aortic Valve Replacement
- Abstract
Background: Percutaneous suture-based arterial access site closure (ProGlide) is commonly applied in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). However, the failure of a suture-based vascular closure device (VCD) may require additional treatment., Aims: We aimed to evaluate the efficacy and safety of bailout access site closure using a large-bore plug-based device (MANTA) in patients with failed suture-based closure during transfemoral TAVI., Methods: Patients undergoing a bailout attempt with the MANTA VCD were identified from a prospectively enrolling, institutional registry. Efficacy was defined as haemostasis at the access site without the need for alternative treatment other than manual compression or endovascular ballooning. Safety was defined as freedom from vascular dissection, stenosis and occlusion requiring intervention., Results: Of 2,505 patients, 66 underwent a bailout attempt with MANTA as a result of ProGlide failure, which occurred before the large-bore sheath insertion in 16.7% of patients and after the sheath removal in 83.3% of patients. Bailout MANTA was deemed effective in 75.8% of patients (50/66), and the technique was considered safe in 86.4% (57/66) of patients. Failure of bailout MANTA occurred because of its superficial application, resulting in persistent bleeding in 18.2% of patients (12/66), and because of its deep application, resulting in stenosis or occlusion in 6.1% of patients (4/66). Operator experience with the technique (odds ratio [OR] 12.29, 95% confidence interval [CI]: 1.99-75.99; p=0.007) and prior use of three ProGlides (OR 0.02, 95% CI: <0.01-0.39; p=0.010) were the only independent predictors of the efficacy endpoint., Conclusions: Bailout MANTA after ProGlide failure was effective and safe, but operator experience seems to be crucial. Further technological refinements to facilitate accurate placement appear necessary.
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- 2024
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46. Erratum zu: ESC-Leitlinien 2023 zum Management der Endokarditis.
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de Waha S, Desch S, Tilz R, Vogler J, Uhlemann M, Marín-Cuartas M, Raschpichler M, and Borger M
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- 2024
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47. Prognostic significance and clinical utility of left atrial reservoir strain in transcatheter aortic valve replacement.
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von Roeder M, Maeder M, Wahl V, Kitamura M, Rotta Detto Loria J, Dumpies O, Rommel KP, Kresoja KP, Blazek S, Richter I, Majunke N, Desch S, Thiele H, Lurz P, and Abdel-Wahab M
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- Humans, Female, Aged, 80 and over, Male, Prognosis, Aortic Valve surgery, Treatment Outcome, Risk Factors, Time Factors, Severity of Illness Index, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis etiology
- Abstract
Aims: Patients with diastolic dysfunction (DD) experience worse outcomes after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value and clinical utility of left atrial reservoir strain (LARS) in patients undergoing TAVR for aortic stenosis (AS)., Methods and Results: All consecutive patients undergoing TAVR between January 2018 and December 2018 were included if discharge echocardiography and follow-up were available. LARS was derived from 2D-speckle-tracking. Patients were grouped into three tertiles according to LARS. DD was analysed using the ASE/EACVI-algorithm. The primary outcome was a composite of all-cause death and readmission for worsening heart failure 12 months after TAVR. Overall, 606 patients were available [age 80 years, interquartile range (IQR) 77-84], including 53% women. Median LARS was 13.0% (IQR 8.4-18.3). Patients were classified by LARS tertiles [mildly impaired 21.4% (IQR 18.3-24.5), moderately impaired 13.0% (IQR 11.3-14.6), severely impaired 7.1% (IQR 5.4-8.4), P < 0.0001]. The primary outcome occurred more often in patients with impaired LARS (mildly impaired 7.4%, moderately impaired 13.4%, and severely impaired 25.7%, P < 0.0001). On adjusted multivariable Cox regression analysis, LARS tertiles [hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.44-0.86, P = 0.005] and higher degree of tricuspid regurgitation (HR 1.82, 95% CI 1.23-2.98, P = 0.003) were the only significant predictors of the primary endpoint. Importantly, DD was unavailable in 56% of patients, but LARS assessment allowed for reliable prognostication regarding the primary endpoint in subgroups without DD assessment (HR 0.64, 95% CI 0.47-0.87, P = 0.003)., Conclusion: Impaired LARS is independently associated with worse outcomes in patients undergoing TAVR. LARS allows for risk stratification at discharge even in patients where DD cannot be assessed by conventional echocardiographic means., Competing Interests: Conflict of interest: M.A.-W. reports that his hospital receives speaker’s honoraria and/or consultancy fees on his behalf from Boston Scientific and Medtronic., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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48. Impact of anaemia and iron deficiency on outcomes in cardiogenic shock complicating acute myocardial infarction.
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Obradovic D, Loncar G, Zeymer U, Pöss J, Feistritzer HJ, Freund A, Jobs A, Fuernau G, Desch S, Ceglarek U, Isermann B, von Haehling S, Anker SD, Büttner P, and Thiele H
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- Male, Humans, Female, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Shock, Cardiogenic diagnosis, Treatment Outcome, Heart Failure complications, Myocardial Infarction complications, Myocardial Infarction therapy, Anemia complications, Anemia, Iron-Deficiency etiology, Percutaneous Coronary Intervention adverse effects
- Abstract
Aims: Anaemia and iron deficiency (ID) are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and acute myocardial infarction (AMI). Nevertheless, data concerning the impact of anaemia and ID on clinical outcomes in patients with cardiogenic shock (CS) are scarce. This study aimed to assess the impact of anaemia and ID on clinical outcomes in patients with CS complicating AMI., Methods and Results: The presence of anaemia (haemoglobin <13 g/dl in men and <12 g/dl in women) or ID (ferritin <100 ng/ml or transferrin saturation <20%) was determined in patients with CS due to AMI from the CULPRIT-SHOCK trial. Blood samples were collected in the catheterization laboratory during initial percutaneous coronary intervention. Clinical outcomes were compared in four groups of patients having neither anaemia nor ID, against patients with anaemia with or without ID and patients with ID only. A total of 427 CS patients were included in this analysis. Anaemia without ID was diagnosed in 93 (21.7%), anaemia with ID in 54 study participants (12.6%), ID without anaemia in 72 patients (16.8%), whereas in 208 patients neither anaemia nor ID was present (48.9%). CS patients with anaemia without ID were older (73 ± 10 years, p = 0.001), had more frequently a history of arterial hypertension (72.8%, p = 0.01), diabetes mellitus (47.8%, p = 0.001), as well as chronic kidney disease (14.1%, p = 0.004) compared to CS patients in other groups. Anaemic CS patients without ID presence were at higher risk to develop a composite from all-cause death or renal replacement therapy at 30-day follow-up (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.23-6.62, p < 0.001) than CS patients without anaemia/ID. The presence of ID in CS patients, with and without concomitant anaemia, did not increase the risk for the primary outcome (OR 1.17, 95% CI 0.64-2.13, p = 0.64; and OR 1.01, 95% CI 0.59-1.73, p = 0.54; respectively) within 30 days of follow-up. In time-to-event Kaplan-Meier analysis, anaemic CS patients without ID had a significantly higher hazard ratio (HR) for the primary outcome (HR 2.11, 95% CI 1.52-2.89, p < 0.001), as well as for death from any cause (HR 1.90, 95% CI 1.36-2.65, p < 0.001) and renal replacement therapy during 30-day follow-up (HR 2.99, 95% CI 1.69-5.31, p < 0.001)., Conclusion: Concomitant anaemia without ID presence in patients with CS at hospital presentation is associated with higher risk for death from any cause or renal replacement therapy and the individual components of this composite endpoint within 30 days after hospitalization. ID has no relevant impact on clinical outcomes in patients with CS., (© 2023 The Authors. 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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49. [ESC guidelines 2023 on the management of endocarditis : What is new?]
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de Waha S, Desch S, Tilz R, Vogler J, Uhlemann M, Marín-Cuartas M, Raschpichler M, and Borger M
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- Humans, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis, Endocarditis therapy, Endocarditis drug therapy, Endocarditis, Bacterial therapy, Endocarditis, Bacterial prevention & control, Cardiology
- Abstract
In August 2023 the new European guidelines on the management of infective endocarditis were published by the European Society of Cardiology (ESC). Numerous recommendations were revised and supplemented by new ones. This review article outlines the essential modifications of the current ESC guidelines focusing on the prevention including antibiotic prophylaxis, the role of the endocarditis team, the revision of the diagnostic criteria, the paradigm shift towards oral antibiotic treatment, the timing and the indications for surgical treatment as well as the relevance of infections of cardiovascular implantable electronic devices., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2024
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50. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. Reply.
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Thiele H, Desch S, and Zeymer U
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- Humans, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Extracorporeal Membrane Oxygenation
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- 2024
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