Diabetes is an independent risk factor for atrial fibrillation (AF). Frequently, it is part of the metabolic syndrome cluster, which includes obesity and hypertension that are independently ...associated with AF. The risk appears to be higher with longer duration of diabetes and inadequate glycemic control. Patients with diabetes and AF have a substantially increased risk of death and serious cardiovascular complications compared with those in sinus rhythm. Conversely, good metabolic control appears to be associated with maintenance of rhythm after successful therapeutic conversion to sinus rhythm by catheter ablation or electrical cardioconversion of AF. AF puts patients with type 2 diabetes at a high risk of cardiovascular complications and death, which could be successfully addressed by new classes of antidiabetic agents such as incretin analogues or sglt-2 inhibitors. Thus, a diagnostic strategy that addresses the increased risk for AF is urgently recommended, in addition to diabetes monitoring in routine outpatient practice. In order to prevent thromboembolic complications, which frequently determine the prognosis for this patient population, appropriate anticoagulation remains the mainstay of therapy, whereas the prognostic value of reinstalling sinus rhythm awaits further evidence.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Aims We sought to assess the feasibility of catheter-based mitral valve repair using the MitraClip system in high-surgical-risk patients with mitral regurgitation (MR) ≥grade 3+. Methods and results ...MitraClip therapy was performed in 51 consecutive patients 73 ± 10 years; 34 (67%) men with symptomatic functional n = 35 (69%) or organic MR n = 16 (31%). Mean logistic EuroSCORE was 29 ± 22%; Society of Thoracic Surgeons score was 15 ± 11. Left ventricular (LV) ejection fraction was 36 ± 17%. In 35 patients (69%), adverse mitral valve morphology and/or severe LV dysfunction were present. MitraClip implantation was successful in 49 patients (96%). Most patients n = 34/49 (69%) were treated with a single clip, whereas 14 patients (29%) received two clips and one patient received three clips. Mean device and fluoroscopy times were 105 ± 65 min and 44 ± 28 min, respectively. Procedure-related reduction in MR severity was one grade in 16 patients (31%), two grades in 24 patients (47%), and three grades in 9 patients (18%). Forty-four of the 49 successfully treated patients (90%) showed clinical improvement at discharge NYHA functional class ≥III in 48 patients (98%) before and 16 patients (33%) after the procedure (P < 0.0001). There were no procedure-related major adverse events and no in-hospital mortality. Conclusion Mitral valve repair using the MitraClip system was shown to be feasible in patients at high surgical risk primarily determined by an adverse mitral valve morphology and/or severe LV dysfunction.
A review is given on the multiconfiguration time-dependent Hartree (MCTDH) method, which is an algorithm for propagating wavepackets. The formal derivation, numerical implementation, and performance ...of the method are detailed. As demonstrated by example applications, MCTDH may perform very efficiently, especially when there are many (typically four to twelve, say) degrees of freedom. The largest system treated with MCTDH to date is the pyrazine molecule, where all 24 (!) vibrational modes were accounted for. The particular representation of the MCTDH wavefunction requires special techniques for generating an initial wavepacket and for analysing the propagated wavefunction. These techniques are discussed. The full efficiency of the MCTDH method is only realised if the Hamiltonian can be written as a sum of products of one-dimensional operators. The kinetic energy operator and many model potential functions already have this required structure. For other potential functions, we describe an efficient algorithm for determining optimal fits of product form. An alternative to the product representation, the correlation discrete variable representation (CDVR) method, is also briefly discussed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Patients with pulmonary hypertension are at risk of developing fatal right heart failure after heart transplantation. To evaluate this risk potential, candidates for heart transplantation are ...screened by measuring rest right heart pressures and the response to nitroprusside. To test the validity of this approach, the influence of pretransplantation right heart catheterization data on outcome after transplantation was analyzed in 293 of 301 consecutive patients.
Patients with a pulmonary vascular resistance >2.5 Wood units measured at baseline study had a 3-month mortality rate of 17.9% compared with 6.9% in patients with resistance ≤ 2.5 units (p < 0.02). Patients with a pulmonary vascular resistance > 2.5 units at baseline study could be differentiated further according to their hemodynamic response to nitroprusside; those whose resistance could be reduced to ≤ 2.5 units with a stable systemic systolic pressure ≥ 85 mm Hg had a 3-month mortality rate of only 3.8%. In contrast, patients whose pulmonary vascular resistance could not be reduced to < 2.5 units, and those whose resistance could be reduced to ≤ 2.5 units but only at the expense of systemic hypotension (systolic pressure ≤ 85 mm Hg) had a 3-month mortality rate of 40.6% and 27.5%, respectively. Furthermore, all 10 patients who died of right heart failure belonged to the latter two groups.
These findings confirm the value of right heart hemodynamic measurements and the response to nitroprusside in predicting early mortality after heart transplantation and, in particular, mortality due to right heart failure. Valid risk stratification based on the hemodynamic response to nitroprusside requires consideration of the concomitant change in systemic pressure.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To test how the organization of a pre-transplant clinic and changes in organ allocation modus influence the survival of potential transplant candidates, the survival of patients referred for ...transplant evaluation between 4/93 and 4/96 (group A) was compared to that of patients referred from 5/96 to 7/00(group B).
After screening for transplant indication, group A was followed by the referring physician up to transplantation or 3-month reevaluation. Group B was closely followed by a specialized heart-failure clinic. Group A was transplanted according to Eurotransplant criteria, with waiting time being the strongest priority criterion. Due to an allocation partnership off our transplant centers, group B could be transplanted according to medical urgency regardless of waiting time.
Overall one-year survival after referral was 69.8% for group A vs. 91 %for group B (p <0.0001). Transplantation within 1 year was required in more group A than group B patients (34% vs. 23%)with worse one-year post-transplant survival in group A (82%vs. 93%).
Intensified treatment by a specialized heart failure program and an allocation system that allows for preferred transplantation of the 'sickest' patient improved over-all survival of transplant candidates and reduced the percentage of patients requiring transplantation.
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