Abstract Background Takotsubo Cardiomyopathy (TTC) is a transient disorder of ventricular wall dysfunction, mostly induced by physical or emotional stress. TTC may be associated with adverse cardiac ...events. The association of cancer and its clinical impact in TTC patients has not been described yet. Methods In 114 consecutive patients presenting with TTC between January 2003 and September 2015, we studied the frequency of cancer diagnosis, and compared the clinical course and the occurrence of a clinical endpoint of cancer and non-cancer patients during a follow up of 4.2 years. Results Of the 114 patients, 16 (14.0%) had a malignancy already diagnosed at TTC, and further 11 patients received the diagnosis during follow up. Cancer patients had higher frequency of atrial fibrillation and lower hemoglobin levels at admission than patients without cancer. While the occurrence of in-hospital events was comparable, the diagnosis of cancer at TTC event or during follow up was predictive for a higher rate of the composite endpoint. In the Kaplan-Meier analysis, malignant diseases were strongly associated not only with overall mortality but also with worsened time of event-free survival during the long-term outcome. Conclusions Prevalence of malignant diseases is high in TTC patients, and is a risk factor for worse outcome. Screening for malignancies should be recommended in all patients presenting with TTC. Further studies are needed to define the association on molecular levels.
Interventional closure of left atrial appendage (LAAC) represents an alternative for stroke prevention in patients with non-valvular atrial fibrillation. Whether LAAC may affect metabolomic pathways ...has not been investigated yet. This study evaluates the impact of LAAC on the metabolism of essential amino acids, kynurenine and creatinine.
Peripheral blood samples of prospectively enrolled patients undergoing successful LAAC were taken before (T0) and 6 months after (T1, mid-term follow-up). Targeted metabolomic profiling was performed using electrospray ionization liquid chromatography–mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements focusing on metabolism of essential amino acids.
44 patients with non-valvular AF (mean CHA2DS2-VASc score 4, mean HAS-BLED score 4) were enrolled. Changes in metabolites of essential amino acids, myocardial contraction and bioenergetic efficacy, such as phenylalanine (percentage change 8.2%, p = 0.006), tryptophan (percentage change 20.3%, p = 0.0006), tyrosine (percentage change 20.2%, p = 0.0001), creatinine (percentage change 7.2%, p > 0.05) and kynurenine (percentage change 8.3%, p = 0.0239) were found at mid-term follow-up.
LAAC may affect the metabolism of essential amino acids and bioenergetic efficacy.
ClinicalTrials.gov Identifier: NCT02985463
•Successful left atrial appendage closure (LAAC) might affect the metabolism of essential amino acids and kynurenine•Pathophysiological alterations due to LAAC include ongoing myocardial contraction, local stretch and device-related neo-endothelization•Changes of these metabolites might reveal the impact of LAAC on bioenergetic efficacy
Koronare Herzerkrankung Behnes, M.; Mashayekhi, K.; Borggrefe, M. ...
Herz,
04/2017, Letnik:
42, Številka:
2
Journal Article
Recenzirano
Zusammenfassung
Die koronare Herzkrankheit (KHK) stellt eine häufige strukturelle Ursache für einen Herzstillstand im höheren Alter dar, während hierfür beim jungen Erwachsenen eher Kardiomyopathien ...oder Ionenkanalerkrankungen ursächlich sind. Strukturelle Herzerkrankungen sind bei etwa der Hälfte der Patienten mit Herzstillstand vorbekannt. Die vorliegende Übersichtsarbeit stellt aktuelle interventionelle und operative Therapiemöglichkeiten nach einem Herzstillstand dar. Schwerpunkte liegen hierbei auf der Darstellung der Zusammenhänge zwischen epidemiologischen Daten zur Inzidenz von malignen Herzrhythmusstörungen als Ursache für einen Herzstillstand in Abhängigkeit des Vorhandenseins einer KHK. Zum anderen wird der mögliche Nutzen einer möglichst frühen koronaren Revaskularisation und einer umgehenden kompletten Revaskularisation gegenüber der alleinigen Therapie der sog. „culprit lesion“ aufgezeigt. Abschließend werden die Vorteile invasiver Therapiemaßnahmen, wie etwa des zielgerichteten Temperaturmanagements und mechanischer Herzunterstützungssysteme für Patienten nach erfolgreich überstandener kardiopulmonaler Reanimation beschrieben. Letztere umfassen die sog. intraaortale Gegenpulsation (IABP) und Möglichkeiten der extrakorporalen Herzunterstützung („extracorporeal life support“, ECSL) zur peripheren und zentralen Unterstützung der rechten und linken Herzkammer.
Coronary artery disease (CAD) represents a common structural cause for developing cardiac arrest in older patients, whereas in young adults cardiac arrest is more often caused by cardiomyopathies and ...cardiac channelopathies. A structural heart disease is known in almost 50% of patients prior to cardiac arrest. The present review outlines current interventional and operative therapeutic options for patients surviving cardiac arrest. The focus is on associations between epidemiological data on the incidence of malignant arrhythmias causing cardiac arrest depending on the presence or absence of CAD. Furthermore, the potential benefits of an early coronary revascularization as well as of a prompt complete coronary revascularization compared to the individual treatment of the so-called culprit lesion only are described. Finally, the advantages of invasive therapies for patients surviving cardiac arrest, such as targeted temperature management and mechanical cardiac assist devices, are elucidated. Cardiac assist devices comprise the use of the intra-aortic balloon pump (IABP) and devices for extracorporeal life support (ECLS) for peripheral and central support of the right and left heart chambers.
Previous studies revealed that patients with Takotsubo cardiomyopathy (TTC) have a higher mortality rate than the general population. It is still unclear whether sex differences may influence ...long-term prognosis of TTC patients. The purpose of this study was to determine whether sex differences do influence the short- and long-term outcomes of TTC.
A total of 114 patients with TTC were admitted to the University Medical Centre Mannheim from January 2003 to September 2015 and entered into the TTC database of the University Medical Centre Mannheim, and retrospectively analyzed. Patients were diagnosed by the Mayo Clinic criteria. All-cause mortality over mean follow-up of 1,529±1,121 days was revealed. Significantly more male patients died within long-term follow-up compared to female TTC patients (log-rank test;
=0.01). Most males died of noncardiac causes. In multivariate Cox regression analysis, the male sex (
=0.02, hazard ratio HR 2.8, 95% CI 1.1-7.2), the ejection fraction ≤35% (
=0.01, HR 3.3, 95% CI 1.2-9.2) and glomerular filtration rate <60 mL/min (
<0.01, HR 3.1, 95% CI 1.4-7.0) figured out as independent predictors of the adverse outcome.
This study shows that males suffering from TTC reveal a higher long-term all-cause mortality rate than females over a 5 year follow-up period.
Takotsubo cardiomyopathy (TTC) is a relevant differential diagnosis in patients presenting with signs of an acute coronary syndrome. Although recent literature has highlighted some salient features ...of this disorder, there has been little information elucidating the differences in clinical features, electrocardiographic findings, echocardiographic data and TTC-related complications associated with the different variants of TTC.
Our institutional database constituted a collective of 114 patients diagnosed with TTC between 2003 and 2015 and these patients were subsequently divided into two groups based on the presence (n = 82, 72%) or absence (n = 32, 28%) of the apical form of TTC. The protocol for our proposed study was approved by the Ethics Committee of the University Medical Centre in Mannheim. It was noticed that the patients presenting with the apical form of TTC belonged to an older age group as compared to those presenting with the non-apical form (61.1 ± 8.9 years vs. 69.5 ± 11.2; P < 0.01). The QTc interval prolongation at index-event was observed to be quantifiably greater in the 'apical variant' patients group (484.8 ± 57 ms vs. 464 ± 34.1 ms; P = 0.06). With respect to cardiovascular risk factors, patients with arterial hypertension did have a higher predilection to present with the apical form (63.4% vs. 43.7%; P = 0.06), however, the impact of smoking was less pronounced in this patient group (24.4% vs. 50%, P = 0.01). Furthermore, our study highlighted a significant impact on ejection fraction (EF), with a compromised left ventricular function (36 ± 9% vs. 42.4 ± 9.7%, P < 0.01) and greater involvement of the right ventricle in the apical variant patients group (23% vs. 3%, P = 0.04). Patients with the apical form also showed a greater tendency to develop TTC-related complications such as cardiogenic shock and required longer monitoring and care in comparison.
The apical and non-apical variants of TTC are manifestations of the same syndrome. They differ significantly, however, in their clinical presentation, related complications and prognosis.
Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce ...the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC. A targeted metabolomics approach based on electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements was performed. A total of 34 lipids revealed a significant change from baseline to mid-term follow-up after successful LAAC. Subgroup analysis revealed confounding influence by gender, age, diabetes mellitus type II, body mass index, left ventricular ejection fraction, creatinine and NT-proBNP. After multivariable adjustment within logistic regression models, these 34 lipids were still significantly altered after LAAC. Successful percutaneous LAAC may affect lipid metabolism and thereby may potentially affect pro-atherogenic and cardio-toxic effects.
A previously healthy 52-year-old man presented to our department with remitting and relapsing fever for more than 6 weeks. During complex staged work-up, we revealed that he suffered from an ...Abiotrophia defectiva endocarditis of the mitral valve with mitral regurgitation and vegetation requiring mitral valve replacement. He recovered well postoperatively and is currently being followed at our Outpatient Cardiology Clinic.
Background
Left atrial appendage (LAA) closure (LAAC) by implantation of an occlusion device is an established cardiac intervention to reduce risk of stroke while avoiding intake of oral ...anticoagulation medication during atrial fibrillation. Cardiac interventions can alter local or systemic gene and protein expression. Effects of LAAC on systemic metabolism have not been studied yet.
Objectives
We aimed to study the effects of interventional LAAC on systemic metabolism.
Methods
Products of glycolysis, tricarboxylic acid and urea metabolism were analyzed by ESI-LC-MS/MS and MS/MS using the AbsoluteIDQ™ p180 Kit in plasma of 44 patients undergoing successful interventional LAAC at baseline (T0) and after 6 months (T1).
Results
During follow up, plasma concentrations of several parameters of glycolysis and tricarboxylic acid cycle (TCA) and urea metabolism increased (alanine, hexose, proline, sarcosine), while others decreased (aspartate, glycine, SDMA, serine). Multivariate linear regression analysis showed that time after interventional LAAC was an independent predictor for metabolite changes, including the decrease of SDMA (beta −0.19, p < 0.01) and the increase of sarcosine (beta 0.16, p < 0.01).
Conclusions
Successful interventional LAAC affects different pathways of the metabolome, which are probably related to cardiac remodeling. The underlying mechanisms as well as the long term effects have to be studied in the future.
Zusammenfassung
Die Koronarangiographie gilt als Goldstandard in der morphologischen Darstellung von Koronarstenosen. Da eine Koronarangiographie häufig in Situationen durchgeführt wird, in denen ...präprozedural kein nicht-invasiver Ischämienachweis erfolgte, und die Einschätzung des Schweregrades einer koronaren Läsion anhand der Morphologie sehr subjektiv ist, stellt die invasive Messung der fraktionellen Flussreserve (FFR) den aktuellen Standard in der kardialen Ischämiediagnostik dar, welche als Klasse-IA-Empfehlung 2014 in die ESC/EACTS-Leitlinien zur Myokardrevaskularisation einging. Sowohl die DEFER- als auch die FAME-Studie konnten keinen Behandlungsvorteil von hämodynamisch nichtrelevanten Stenosen zeigen. Durch den Einsatz von FFR mit gezielten Interventionen konnten sowohl die klinischen Ergebnisse verbessert als auch die Verfahrenskosten gesenkt werden. Jedoch ist der Einsatz im klinischen Alltag oftmals weiterhin eingeschränkt. Die iFR® („instantaneous wave-free ratio“) bildet einen innovativen Ansatz zur Bestimmung der hämodynamischen Relevanz von Koronarstenosen ohne den Einsatz von Vasodilatatoren. In Bezug auf periprozedurale Komplikationen sowie die Prognose konnte in der iFR-SWEDEHEART- und der DEFINE-FLAIR-Studie eine Nichtunterlegenheit der iFR® im direkten Vergleich zur FFR belegt werden.
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