14039
2011
eng
1-8
15
10
article
1
2016-11-15
--
--
Heart failure therapy in diabetic patients-comparison with the recent ESC/EASD guideline
Background:
To assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function.
Methods:
3304 patients with heart failure from 9 different studies were included (mean age 63 +/- 14 years); out of these, 711 subjects had preserved left ventricular ejection fraction (>= 50%) and 994 patients in the whole cohort suffered from diabetes.
Results:
The majority (>90%) of heart failure patients with reduced ejection fraction (SHF) and diabetes were treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) or with beta-blockers. By contrast, patients with diabetes and preserved ejection fraction (HFNEF) were less likely to receive these substance classes (p < 0.001) and had a worse blood pressure control (p < 0.001). In comparison to patients without diabetes, the probability to receive these therapies was increased in diabetic HFNEF patients (p < 0.001), but not in diabetic SHF patients. Aldosterone receptor blockers were given more often to diabetic patients with reduced ejection fraction (p < 0.001), and the presence and severity of diabetes decreased the probability to receive this substance class, irrespective of renal function.
Conclusions:
Diabetic patients with HFNEF received less heart failure medication and showed a poorer control of blood pressure as compared to diabetic patients with SHF. SHF patients with diabetes were less likely to receive aldosterone receptor blocker therapy, irrespective of renal function.
Cardiovascular Diabetology
10.1186/1475-2840-10-15
urn:nbn:de:bvb:20-opus-140397
Cardiovascular Diabetology 2011 10:15.
Frank Edelmann
Rolf Wachter
Hans-Dirk Düngen
Stefan Störk
Annette Richter
Raoul Stahrenberg
Till Neumann
Claus Lüers
Christiane E. Angermann
Felix Mehrhof
Götz Gelbrich
Burkert Pieske
eng
uncontrolled
Preserved Ejection Fraction
eng
uncontrolled
Diastocic Dysfunction
eng
uncontrolled
Myocardial-Infarction
eng
uncontrolled
Hyperkalemia
eng
uncontrolled
Eplerenone
deu
uncontrolled
Mortality
deu
uncontrolled
Predictors
deu
uncontrolled
Framingham
deu
uncontrolled
Morbidity
deu
uncontrolled
Outcomes
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/14039/063_Edelmann_CARDIOVASCULAR-DIABETOLOGY.pdf
13435
2011
eng
755-764
9
100
article
1
2016-06-03
--
--
Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction
Background
Comorbidities negatively affect prognosis more strongly in heart failure with preserved (HFpEF) than with reduced (HFrEF) ejection fraction. Their comparative impact on physical impairment in HFpEF and HFrEF has not been evaluated so far.
Methods and results
The frequency of 12 comorbidities and their impact on NYHA class and SF-36 physical functioning score (SF-36 PF) were evaluated in 1,294 patients with HFpEF and 2,785 with HFrEF. HFpEF patients had lower NYHA class (2.0 ± 0.6 vs. 2.4 ± 0.6, p < 0.001) and higher SF-36 PF score (54.4 ± 28.3 vs. 54.4 ± 27.7, p < 0.001). All comorbidities were significantly (p < 0.05) more frequent in HFrEF, except hypertension and obesity, which were more frequent in HFpEF (p < 0.001). Adjusting for age and gender, COPD, anemia, hyperuricemia, atrial fibrillation, renal dysfunction, cerebrovascular disease and diabetes had a similar (p for interaction > 0.05) negative effect in both groups. Obesity, coronary artery disease and peripheral arterial occlusive disease exerted a significantly (p < 0.05) more adverse effect in HFpEF, while hypertension and hyperlipidemia were associated with fewer (p < 0.05) symptoms in HFrEF only. The total impact of comorbidities on NYHA (AUC for prediction of NYHA III/IV vs. I/II) and SF-36 PF (r 2) in multivariate analyses was approximately 1.5-fold higher in HFpEF, and also much stronger than the impact of a 10% decrease in ejection fraction in HFrEF or a 5 mm decrease in left ventricular end-diastolic diameter in HFpEF.
Conclusion
The impact of comorbidities on physical impairment is higher in HFpEF than in HFrEF. This should be considered in the differential diagnosis and in the treatment of patients with HFpEF.
Clinical Research in Cardiology
10.1007/s00392-011-0305-4
urn:nbn:de:bvb:20-opus-134354
Clin Res Cardiol (2011) 100:755–764
false
true
Frank Edelmann
Raoul Stahrenberg
Götz Gelbrich
Kathleen Durstewitz
Christiane E. Angermann
Hans-Dirk Düngen
Thomas Scheffold
Christian Zugck
Bernhard Maisch
Vera Regitz-Zagrosek
Gerd Hasenfuß
Burkert M. Pieske
Rolf Wachter
eng
uncontrolled
Heart failure with preserved ejection fraction
eng
uncontrolled
Heart failure with reduced ejection fraction
eng
uncontrolled
Comorbidities
eng
uncontrolled
Physical impairment
Krankheiten
open_access
Medizinische Klinik und Poliklinik I
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/13435/029_Edelmann_Clinical_Research.pdf
14993
2015
eng
e000182
2
article
1
2017-06-06
--
--
Natriuretic peptides for the detection of paroxysmal atrial fibrillation
Background and purpose:
Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study.
Methods:
Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF.
Results:
244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0) pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3–141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively.
Conclusions:
NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism.
Open Heart
10.1136/openhrt-2014-000182
PMC4533200
urn:nbn:de:bvb:20-opus-149939
Open Heart 2015;2:e000182. DOI: 10.1136/openhrt-2014-000182
CC BY-NC: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell 4.0 International
Joachim Seegers
Markus Zabel
Timo Grüter
Antje Ammermann
Mark Weber-Krüger
Frank Edelmann
Götz Gelbrich
Lutz Binder
Christoph Herrmann-Lingen
Klaus Gröschel
Gerd Hasenfuß
Nicolas Feltgen
Burkert Pieske
Rolf Wachter
eng
uncontrolled
paroxysmal atrial fibrillation
eng
uncontrolled
ischaemic stroke
eng
uncontrolled
natriuretic peptide levels
Medizin und Gesundheit
open_access
Institut für Klinische Epidemiologie und Biometrie
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/14993/107_Seegers_Open_Heart.pdf
19102
2016
eng
140-149
2
4
article
1
2019-10-31
--
--
Tolerability and feasibility of beta-blocker titration in HFpEF versus HFrEF: Insights from the CIBIS-ELD trial
OBJECTIVES: This study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction.
BACKGROUND: Broad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain.
METHODS: In the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro-B-type natriuretic peptide).
RESULTS: For both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23% vs. HFrEF: 34%, p < 0.001). Mean E/e' and left atrial volume index did not change in either group, although E/A increased in HFpEF. CONCLUSIONS: BB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and Left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure HF] Patients: A Randomised, Double-Blind Multicentre Study CIBIS-ELD]; ISRCTN34827306).
JACC: Heart Failure
10.1016/j.jchf.2015.10.008
urn:nbn:de:bvb:20-opus-191022
JACC: Heart Failure (2016) 4:2, S. 140-149. https://doi.org/10.1016/j.jchf.2015.10.008
true
true
CC BY-NC-ND: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell, Keine Bearbeitungen 4.0 International
Frank Edelmann
Lindy Musial-Bright
Goetz Gelbrich
Tobias Trippel
Sara Radenovic
Rolf Wachter
Simone Inkrot
Goran Loncar
Elvis Tahirovic
Vera Celic
Jovan Veskovic
Marija Zdravkovic
Mitja Lainscak
Svetlana Apostolović
Aleksandar N. Neskovic
Burkert Pieske
Hans-Dirk Düngen
eng
uncontrolled
beta-blockers
eng
uncontrolled
heart failure
eng
uncontrolled
HFpEF
eng
uncontrolled
HFrEF
eng
uncontrolled
tolerability
Medizin und Gesundheit
open_access
Institut für Klinische Epidemiologie und Biometrie
Institut für Medizinische Lehre und Ausbildungsforschung
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/19102/Edelmann_JACC_HeartFailure_2016.pdf
21269
2020
eng
973
983
3
7
article
1
--
--
--
Inferior vena cava ultrasound in acute decompensated heart failure: design rationale of the CAVA‐ADHF‐DZHK10 trial
Aims
Treating patients with acute decompensated heart failure (ADHF) presenting with volume overload is a common task. However, optimal guidance of decongesting therapy and treatment targets are not well defined. The inferior vena cava (IVC) diameter and its collapsibility can be used to estimate right atrial pressure, which is a measure of right‐sided haemodynamic congestion. The CAVA‐ADHF‐DZHK10 trial is designed to test the hypothesis that ultrasound assessment of the IVC in addition to clinical assessment improves decongestion as compared with clinical assessment alone.
Methods and results
CAVA‐ADHF‐DZHK10 is a randomized, controlled, patient‐blinded, multicentre, parallel‐group trial randomly assigning 388 patients with ADHF to either decongesting therapy guided by ultrasound assessment of the IVC in addition to clinical assessment or clinical assessment alone. IVC ultrasound will be performed daily between baseline and hospital discharge in all patients. However, ultrasound results will only be reported to treating physicians in the intervention group. Treatment target is relief of congestion‐related signs and symptoms in both groups with the additional goal to reduce the IVC diameter ≤21 mm and increase IVC collapsibility >50% in the intervention group. The primary endpoint is change in N‐terminal pro‐brain natriuretic peptide from baseline to hospital discharge. Secondary endpoints evaluate feasibility, efficacy of decongestion on other scales, and the impact of the intervention on clinical endpoints.
Conclusions
CAVA‐ADHF‐DZHK10 will investigate whether IVC ultrasound supplementing clinical assessment improves decongestion in patients admitted for ADHF.
ESC Heart Failure
10.1002/ehf2.12598
urn:nbn:de:bvb:20-opus-212692
swordwue
2020-10-05T16:09:44+00:00
attachment; filename=deposit.zip
f0246960fffd176e2016a491d7fa2e5a
ESC Heart Failure 2020, 7(3):973-983. DOI: 10.1002/ehf2.12598
false
true
CC BY-NC: Creative-Commons-Lizenz: Namensnennung, Nicht kommerziell 4.0 International
Alexander Jobs
Reinhard Vonthein
Inke R. König
Jane Schäfer
Matthias Nauck
Svenja Haag
Carlo Federico Fichera
Thomas Stiermaier
Jakob Ledwoch
Alisa Schneider
Miroslava Valentova
Stephan von Haehling
Stefan Störk
Dirk Westermann
Tobias Lenz
Natalie Arnold
Frank Edelmann
Philipp Seppelt
Stephan Felix
Matthias Lutz
Felix Hedwig
Martin Borggrefe
Clemens Scherer
Steffen Desch
Holger Thiele
eng
uncontrolled
acute decompensated heart failure
eng
uncontrolled
inferior vena cava
eng
uncontrolled
congestion
eng
uncontrolled
NT‐proBNP
eng
uncontrolled
ultrasound
Medizin und Gesundheit
open_access
Import
Deutsches Zentrum für Herzinsuffizienz (DZHI)
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/21269/EHF2_EHF212598.pdf
32399
2023
eng
868-879
7
112
article
1
--
--
--
Prevalence and prognostic impact of chronic kidney disease and anaemia across ACC/AHA precursor and symptomatic heart failure stages
Background
The importance of chronic kidney disease (CKD) and anaemia has not been comprehensively studied in asymptomatic patients at risk for heart failure (HF) versus those with symptomatic HF. We analysed the prevalence, characteristics and prognostic impact of both conditions across American College of Cardiology/American Heart Association (ACC/AHA) precursor and HF stages A–D.
Methods and results
2496 participants from three non-pharmacological German Competence Network HF studies were categorized by ACC/AHA stage; stage C patients were subdivided into C1 and C2 (corresponding to NYHA classes I/II and III, respectively). Overall, patient distribution was 8.1%/35.3%/32.9% and 23.7% in ACC/AHA stages A/B/C1 and C2/D, respectively. These subgroups were stratified by the absence ( – ) or presence ( +) of CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m2) and anaemia (haemoglobin in women/men < 12/ < 13 g/dL). The primary outcome was all-cause mortality at 5-year follow-up. Prevalence increased across stages A/B/C1 and C2/D (CKD: 22.3%/23.6%/31.6%/54.7%; anaemia: 3.0%/7.9%/21.7%/33.2%, respectively), with concordant decreases in median eGFR and haemoglobin (all p < 0.001). Across all stages, hazard ratios [95% confidence intervals] for all-cause mortality were 2.1 [1.8–2.6] for CKD + , 1.7 [1.4–2.0] for anaemia, and 3.6 [2.9–4.6] for CKD + /anaemia + (all p < 0.001). Population attributable fractions (PAFs) for 5-year mortality related to CKD and/or anaemia were similar across stages A/B, C1 and C2/D (up to 33.4%, 30.8% and 34.7%, respectively).
Conclusions
Prevalence and severity of CKD and anaemia increased across ACC/AHA stages. Both conditions were individually and additively associated with increased 5-year mortality risk, with similar PAFs in asymptomatic patients and those with symptomatic HF.
Clinical Research in Cardiology
10.1007/s00392-022-02027-w
urn:nbn:de:bvb:20-opus-323990
@articleGerhardt.2023, author = Gerhardt, Louisa M. S. and Kordsmeyer, Maren and Sehner, Susanne and Güder, Gülmisal and Störk, Stefan and Edelmann, Frank and Wachter, Rolf and Pankuweit, Sabine and Prettin, Christiane and Ertl, Georg and Wanner, Christoph and Angermann, Christiane E., year = 2023, title = Prevalence and prognostic impact of chronic kidney disease and anaemia across ACC/AHA precursor and symptomatic heart failure stages, pages = 868–879, volume = 112, number = 7, journal = Clinical research in cardiology : official journal of the German Cardiac Society, doi = 10.1007/s00392-022-02027-w
md5:4e5de8f6f5b78910d93e5b7deaeacbcd
2023-08-12T09:13:03+00:00
/tmp/phpcmFGfP
bibtex
64d74d1f784180.65360981
Clinical Research in Cardiology (2023) 112:17, 868-879 DOI: 10.1007/s00392-022-02027-w
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Louisa M. S. Gerhardt
Maren Kordsmeyer
Susanne Sehner
Gülmisal Güder
Stefan Störk
Frank Edelmann
Rolf Wachter
Sabine Pankuweit
Christiane Prettin
Georg Ertl
Christoph Wanner
Christiane E. Angermann
eng
uncontrolled
anaemia
eng
uncontrolled
ACC/AHA classification
eng
uncontrolled
chronic kidney disease
eng
uncontrolled
comorbidity
eng
uncontrolled
heart failure
eng
uncontrolled
mortality
Medizin und Gesundheit
open_access
Medizinische Klinik und Poliklinik I
Deutsches Zentrum für Herzinsuffizienz (DZHI)
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/32399/s00392-022-02027-w.pdf