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2. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock

Author

Møller, J. E., Engstrøm, T., Jensen, L. O., Eiskjær, H., Mangner, N., Polzin, A., Schulze, P. C., Skurk, C., Nordbeck, P., Clemmensen, P., Panoulas, V., Zimmer, S., Schäfer, A., Werner, N., Frydland, M., Holmvang, L., Kjærgaard, J., Sørensen, R., Lønborg, J., Lindholm, M. G., Udesen, N. L.J., Junker, A., Schmidt, H., Terkelsen, C. J., Christensen, S., Christiansen, E. H., Linke, A., Woitek, F. J., Westenfeld, R., Möbius-Winkler, S., Wachtell, K., Ravn, H. B., Lassen, J. F., Boesgaard, S., Gerke, O., Hassager, C., Møller, J. E., Engstrøm, T., Jensen, L. O., Eiskjær, H., Mangner, N., Polzin, A., Schulze, P. C., Skurk, C., Nordbeck, P., Clemmensen, P., Panoulas, V., Zimmer, S., Schäfer, A., Werner, N., Frydland, M., Holmvang, L., Kjærgaard, J., Sørensen, R., Lønborg, J., Lindholm, M. G., Udesen, N. L.J., Junker, A., Schmidt, H., Terkelsen, C. J., Christensen, S., Christiansen, E. H., Linke, A., Woitek, F. J., Westenfeld, R., Möbius-Winkler, S., Wachtell, K., Ravn, H. B., Lassen, J. F., Boesgaard, S., Gerke, O., and Hassager, C.

Abstract

BACKGROUND The effects of temporary mechanical circulatory support with a microaxial flow pump on mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock remains unclear. METHODS In an international, multicenter, randomized trial, we assigned patients with STEMI and cardiogenic shock to receive a microaxial flow pump (Impella CP) plus standard care or standard care alone. The primary end point was death from any cause at 180 days. A composite safety end point was severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation. RESULTS A total of 360 patients underwent randomization, of whom 355 were included in the final analysis (179 in the microaxial-flow-pump group and 176 in the standard-care group). The median age of the patients was 67 years, and 79.2% were men. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial-flow-pump group and in 103 of 176 patients (58.5%) in the standard-care group (hazard ratio, 0.74; 95% confidence interval [CI], 0.55 to 0.99; P=0.04). A composite safety end-point event occurred in 43 patients (24.0%) in the microaxial-flow-pump group and in 11 (6.2%) in the standard-care group (relative risk, 4.74; 95% CI, 2.36 to 9.55). Renal-replacement therapy was administered to 75 patients (41.9%) in the microaxial-flow-pump group and to 47 patients (26.7%) in the standard-care group (relative risk, 1.98; 95% CI, 1.27 to 3.09). CONCLUSIONS The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone. The incidence of a composite of adverse events was higher with the use of the microaxial flow pump. (Funded by the Danish Heart Foundation and Abiomed; DanGer Shock ClinicalTrials.gov number, NCT01633502.), background The effects of temporary mechanical circulatory support with a microaxial flow pump on mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock remains unclear. METHODS In an international, multicenter, randomized trial, we assigned patients with STEMI and cardiogenic shock to receive a microaxial flow pump (Impella CP) plus standard care or standard care alone. The primary end point was death from any cause at 180 days. A composite safety end point was severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation. RESULTS A total of 360 patients underwent randomization, of whom 355 were included in the final analysis (179 in the microaxial-flow-pump group and 176 in the standard-care group). The median age of the patients was 67 years, and 79.2% were men. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial-flow-pump group and in 103 of 176 patients (58.5%) in the standard-care group (hazard ratio, 0.74; 95% confidence interval [CI], 0.55 to 0.99; P=0.04). A composite safety end-point event occurred in 43 patients (24.0%) in the microaxial-flow-pump group and in 11 (6.2%) in the standard-care group (relative risk, 4.74; 95% CI, 2.36 to 9.55). Renal-replacement therapy was administered to 75 patients (41.9%) in the microaxial-flow-pump group and to 47 patients (26.7%) in the standard-care group (relative risk, 1.98; 95% CI, 1.27 to 3.09). CONCLUSIONS The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone. The incidence of a composite of adverse events was higher with the use of the microaxial flow pump. (Funded by the Danish Heart Foundation and Abiomed; DanGer Shock ClinicalTrials.gov number, NCT01633502.)

Published
2024

8. (876) Preoperative Recipient CRP/Albumin Ratio Predicts Survival and Outcome after Heart Transplantation

Author

Oehler, D., primary, Immohr, M.B., additional, Böttger, C., additional, Bruno, R.R., additional, Sigetti, D., additional, Haschemi, J., additional, Scheiber, D., additional, Aubin, H., additional, Horn, P., additional, Tudorache, I., additional, Westenfeld, R., additional, Bönner, F., additional, Akhyari, P., additional, Kelm, M., additional, Lichtenberg, A., additional, and Boeken, U., additional

Published
2023
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17. Use of mechanical circulatory support in patients with non-ischemic cardiogenic shock

Author

Schrage, B, primary, Sundermeyer, J, additional, Blankenberg, S, additional, Graf, T, additional, Kirchhof, P, additional, Luedike, P, additional, Nordbeck, P, additional, Proudfoot, A, additional, Orban, M, additional, Skurk, C, additional, Tavazzi, G, additional, Thiele, H, additional, Winzer, E B, additional, Westenfeld, R, additional, and Westermann, D, additional

Published
2022
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19. Absolute treatment effects of novel oral antidiabetic drugs on cardiovascular mortality and hospitalization for heart failure: a meta-analysis of digitalized individual patient outcomes

Author

Wolff, G, primary, Lin, Y, additional, Akbulut, C, additional, Brockmeyer, M, additional, Parco, C, additional, Hoss, A, additional, Sokolowski, A, additional, Westenfeld, R, additional, Kelm, M, additional, Roden, M, additional, Schlesinger, S, additional, and Kuss, O, additional

Published
2022
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28. Sympathetic hyperactivity influences chemosensor function in patients with end-stage renal disease

Author

Meyer C, Schueller P, Balzer J, Lauer T, Westenfeld R, Schauerte P, Hennersdorf M, Steiner S, Kelm M, and Rassaf T

Subjects
chemoreflexes, end-stage renal disease, nervous system, sympathetic, Medicine
Abstract

Abstract Background Autonomic neuropathy is common in patients suffering from end-stage renal disease (ESRD). This may in part explain the high cardiovascular mortality in these patients. Chemosensory function is involved in autonomic cardiovascular control and is mechanistically linked to the sympathetic tone. Objective The aim of the present study was to assess whether sympathetic hyperactivity contributes to an altered chemosensory function in ESRD. Materials and methods In a randomized, double-masked, placebo controlled crossover design we studied the impact of chemosensory deactivation on heart rate, blood pressure and oxygen saturation in 10 ESRD patients and 10 age and gender matched controls. The difference in the R-R intervals divided by the difference in the oxygen pressures before and after deactivation of the chemoreceptors by 5-min inhalation of 7 L oxygen was calculated as the hyperoxic chemoreflex sensitivity (CHRS). Placebo consisted of breathing room air. Baseline sympathetic activity was characterized by plasma catecholamine levels and 24-h time-domain heart rate variability (HRV) parameters. Results Plasma norepinephrine levels were increased (1.6 ± 0.4 vs. 5.8 ± 0.6; P < 0.05) while the SDNN (standard deviation of all normal R-R intervals: 126.4 ± 19 vs. 100.2 ± 12 ms), the RMSSD (square root of the mean of the squared differences between adjacent normal R-R intervals: 27.1 ± 8 vs. 15.7 ± 2 ms), and the 24-h triangular index (33.6 ± 4 vs. 25.7 ± 3; each P < 0.05) were decreased in ESRD patients as compared to controls. CHRS was impaired in ESRD patients (2.9 ± 0.9 ms/mmHg, P < 0.05) as compared to controls (7.9 ± 1.4 ms/mmHg). On multiple regression analysis 24 h-Triangular index, RMSSD, and plasma norepinephrine levels were independent predictors of an impaired hyperoxic CHRS. Conclusion Sympathetic hyperactivity influences chemosensory function in ESRD resulting in an impaired hyperoxic CHRS.

Published
2009
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33. On-device artificial intelligence: mobile solution for detecting severe aortic valve stenosis based on heart sounds

Author

Makimoto, H, primary, Shiraga, T, additional, Kohlmann, B, additional, Magnisali, C.-E, additional, Schenk, R, additional, Gerguri, S, additional, Motoyama, N, additional, Clasen, L, additional, Bejinariu, A, additional, Schmidt, J, additional, Brinkmeyer, C, additional, Westenfeld, R, additional, Zeus, T, additional, and Kelm, M, additional

Published
2021
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34. Dialyse- und Ultrafiltrationsverfahren bei kardiorenalem Syndrom: Empfehlung der Arbeitsgemeinschaft „Herz – Niere“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. und der Deutschen Gesellschaft für Nephrologie e.V.

Author

Schwenger, V., Remppis, B.A., Westenfeld, R., Weinreich, T., Brunkhorst, R., Schieren, G., Krumme †, B., Haller, H., Schmieder, R., Schlieper, G., Frye, B., Hoppe, U.C., Hoyer, J., Keller, T., Blumenstein, M., Schunkert, H., Mahfoud, F., and Rump, L.C.

Published
2014
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36. Human myocardial mitochondrial oxidative capacity is impaired in mild acute heart transplant rejection

Author

Scheiber, D., Zweck, E., Albermann, S., Jelenik, T., Spieker, M., Bönner, F., Horn, P., Schultheiss, H.P., Aleshcheva, G., Escher, F., Boeken, U., Akhyari, P., Roden, M., Kelm, M., Szendroedi, J., and Westenfeld, R.

Subjects
Heart Diseases, Heart failure, Original Articles, Mitochondria, Heart, Acute cellular heart transplant rejection, Oxidative Stress, Diabetes Mellitus, Type 2, Myocardial inflammation, RC666-701, Diseases of the circulatory (Cardiovascular) system, Heart Transplantation, Humans, Original Article, Acute Cellular Heart Transplant Rejection, Heart Failure, Mitochondrial Respiration, Myocardial Inflammation, Mitochondrial respiration
Abstract

AIMS: Acute cellular rejection (ACR) following heart transplantation (HTX) is associated with long-term graft loss and increased mortality. Disturbed mitochondrial bioenergetics have been identified as pathophysiological drivers in heart failure, but their role in ACR remains unclear. We aimed to prove functional disturbances of myocardial bioenergetics in human heart transplant recipients with mild ACR by assessing myocardial mitochondrial respiration using high-resolution respirometry, digital image analysis of myocardial inflammatory cell infiltration, and clinical assessment of HTX patients. We hypothesized that (i) mild ACR is associated with impaired myocardial mitochondrial respiration and (ii) myocardial inflammation, systemic oxidative stress, and myocardial oedema relate to impaired mitochondrial respiration and myocardial dysfunction. METHODS AND RESULTS: We classified 35 HTX recipients undergoing endomyocardial biopsy according International Society for Heart and Lung Transplantation criteria to have no (0R) or mild (1R) ACR. Additionally, we quantified immune cell infiltration by immunohistochemistry and digital image analysis. We analysed mitochondrial substrate utilization in myocardial fibres by high-resolution respirometry and performed cardiovascular magnetic resonance (CMR). ACR (1R) was diagnosed in 12 patients (34%), while the remaining 23 patients revealed no signs of ACR (0R). Underlying cardiomyopathies (dilated cardiomyopathy 50% vs. 65%; P=0.77), comorbidities (type 2 diabetes mellitus: 50% vs. 35%, P=0.57; chronic kidney disease stage 5: 8% vs. 9%, P>0.99; arterial hypertension: 59% vs. 30%, P=0.35), medications (tacrolimus: 100% vs. 91%, P=0.54; mycophenolate mofetil: 92% vs. 91%, P>0.99; prednisolone: 92% vs. 96%, P>0.99) and time post-transplantation (21.5±26.0months vs. 29.4±26.4months, P=0.40) were similar between groups. Mitochondrial respiration was reduced by 40% in ACR (1R) compared with ACR (0R) (77.8±23.0 vs. 128.0±33.0; P14 CD3+ -lymphocytes/mm2 (100% sensitivity, 82% specificity; P&nbsp

Published
2021

44. Typ-2-Diabetes-induzierte NFκB-Expression im humanen Myokard korreliert mit eingeschränkter Komplex-I-assoziierter Mitochondrienfunktion

Author

Zweck, E, additional, Scheiber, D, additional, Jelenik, T, additional, Horn, P, additional, Pesta, D, additional, Lassner, D, additional, Schultheiss, HP, additional, Boeken, U, additional, Akhyari, P, additional, Lichtenberg, A, additional, Kelm, M, additional, Roden, M, additional, Westenfeld, R, additional, and Szendroedi, J, additional

Published
2021
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