TY - JOUR A1 - Traub, Jan A1 - Frey, Anna A1 - Störk, Stefan T1 - Chronic neuroinflammation and cognitive decline in patients with cardiac disease: evidence, relevance, and therapeutic implications JF - Life N2 - Acute and chronic cardiac disorders predispose to alterations in cognitive performance, ranging from mild cognitive impairment to overt dementia. Although this association is well-established, the factors inducing and accelerating cognitive decline beyond ageing and the intricate causal pathways and multilateral interdependencies involved remain poorly understood. Dysregulated and persistent inflammatory processes have been implicated as potentially causal mediators of the adverse consequences on brain function in patients with cardiac disease. Recent advances in positron emission tomography disclosed an enhanced level of neuroinflammation of cortical and subcortical brain regions as an important correlate of altered cognition in these patients. In preclinical and clinical investigations, the thereby involved domains and cell types of the brain are gradually better characterized. Microglia, resident myeloid cells of the central nervous system, appear to be of particular importance, as they are extremely sensitive to even subtle pathological alterations affecting their complex interplay with neighboring astrocytes, oligodendrocytes, infiltrating myeloid cells, and lymphocytes. Here, we review the current evidence linking cognitive impairment and chronic neuroinflammation in patients with various selected cardiac disorders including the aspect of chronic neuroinflammation as a potentially druggable target. KW - neuroinflammation KW - cognitive impairment KW - dementia KW - myocardial infarction KW - heart failure KW - hypertension KW - coronary artery disease KW - atrial fibrillation KW - cardiac arrest KW - aortic valve stenosis Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304869 SN - 2075-1729 VL - 13 IS - 2 ER - TY - JOUR A1 - Rauch, Bernhard A1 - Salzwedel, Annett A1 - Bjarnason-Wehrens, Birna A1 - Albus, Christian A1 - Meng, Karin A1 - Schmid, Jean-Paul A1 - Benzer, Werner A1 - Hackbusch, Matthes A1 - Jensen, Katrin A1 - Schwaab, Bernhard A1 - Altenberger, Johann A1 - Benjamin, Nicola A1 - Bestehorn, Kurt A1 - Bongarth, Christa A1 - Dörr, Gesine A1 - Eichler, Sarah A1 - Einwang, Hans-Peter A1 - Falk, Johannes A1 - Glatz, Johannes A1 - Gielen, Stephan A1 - Grilli, Maurizio A1 - Grünig, Ekkehard A1 - Guha, Manju A1 - Hermann, Matthias A1 - Hoberg, Eike A1 - Höfer, Stefan A1 - Kaemmerer, Harald A1 - Ladwig, Karl-Heinz A1 - Mayer-Berger, Wolfgang A1 - Metzendorf, Maria-Inti A1 - Nebel, Roland A1 - Neidenbach, Rhoia Clara A1 - Niebauer, Josef A1 - Nixdorff, Uwe A1 - Oberhoffer, Renate A1 - Reibis, Rona A1 - Reiss, Nils A1 - Saure, Daniel A1 - Schlitt, Axel A1 - Völler, Heinz A1 - Känel, Roland von A1 - Weinbrenner, Susanne A1 - Westphal, Ronja T1 - Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — Part 1 JF - Journal of Clinical Medicine N2 - Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation. KW - cardiac rehabilitation standards KW - scientific guidelines KW - secondary prevention KW - coronary artery disease KW - chronic heart failure KW - heart valve repair KW - ICD-CRT KW - ventricular assist device KW - heart transplantation KW - peripheral artery disease KW - pulmonary hypertension KW - myocarditis KW - adults with congenital heart disease Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239709 SN - 2077-0383 VL - 10 IS - 10 ER - TY - JOUR A1 - Werner, Rudolf A. A1 - Chen, Xinyu A1 - Rowe, Steven P. A1 - Lapa, Constantin A1 - Javadi, Mehrbod S. A1 - Higuchi, Takahiro T1 - Moving into the Next Era of PET Myocardial Perfusion Imaging - Introduction of Novel \(^{18}\)F-labeled Tracers JF - The International Journal of Cardiovascular Imaging N2 - The heart failure (HF) epidemic continues to rise with coronary artery disease (CAD) as one of its main causes. Novel concepts for risk stratification to guide the referring cardiologist towards revascularization procedures are of significant value. Myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) agents has demonstrated high accuracy for the detection of clinically relevant stenoses. With positron emission tomography (PET) becoming more widely available, mainly due to its diagnostic performance in oncology, perfusion imaging with that modality is more practical than in the past and overcomes existing limitations of SPECT MPI. Advantages of PET include more reliable quantification of absolute myocardial blood flow, the routine use of computed tomography for attenuation correction, a higher spatiotemporal resolution and a higher count sensitivity. Current PET radiotracers such as rubidium-82 (half-life, 76 sec), oxygen-15 water (2 min) or nitrogen-13 ammonia (10 min) are labeled with radionuclides with very short half-lives, necessitating that stress imaging is performed under pharmacological vasodilator stress instead of exercise testing. However, with the introduction of novel 18F-labeled MPI PET radiotracers (half-life, 110 min), the intrinsic advantages of PET can be combined with exercise testing. Additional advantages of those radiotracers include, but are not limited to: potentially improved cost-effectiveness due to the use of pre-existing delivery systems and superior imaging qualities, mainly due to the shortest positron range among available PET MPI probes. In the present review, widely used PET MPI radiotracers will be reviewed and potential novel 18F-labeled perfusion radiotracers will be discussed. KW - heart failure with mid-range ejection fraction KW - Positronenemissionstomografie KW - coronary artery disease KW - precision medicine KW - positron emission tomography KW - PET KW - SPECT KW - myocardial perfusion imaging KW - MPI KW - 18F-flurpiridaz KW - 18FFBnTP KW - HFmrEF Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-169134 SN - 1569-5794 ER - TY - JOUR A1 - Morbach, Caroline A1 - Wagner, Martin A1 - Güntner, Stefan A1 - Malsch, Carolin A1 - Oezkur, Mehmet A1 - Wood, David A1 - Kotseva, Kornelia A1 - Leyh, Rainer A1 - Ertl, Georg A1 - Karmann, Wolfgang A1 - Heuschmann, Peter U A1 - Störk, Stefan T1 - Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort JF - BMC Cardiovascular Disorders N2 - Background: Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation. Methods: Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered. Results: 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription. Conclusions: In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists. Trial registration: This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial. KW - awareness KW - heart failure KW - pharmacotherapy KW - coronary artery disease KW - coronary heart disease KW - euroaspire KW - guideline adherence KW - guideline implementation KW - mineralocorticoid antagonist KW - preserved ejection fraction Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157738 VL - 17 IS - 108 ER - TY - JOUR A1 - Gyberg, Viveca A1 - De Bacquer, Dirk A1 - De Backer, Guy A1 - Jennings, Catriona A1 - Kotseva, Kornelia A1 - Mellbin, Linda A1 - Schnell, Oliver A1 - Tuomilehto, Jaakko A1 - Wood, David A1 - Ryden, Lars A1 - Amouyel, Philippe A1 - Bruthans, Jan A1 - Conde, Almudena Castro A1 - Cifkova, Renata A1 - Deckers, Jaap W. A1 - De Sutter, Johan A1 - Dilic, Mirza A1 - Dolzhenko, Maryna A1 - Erglis, Andrejs A1 - Fras, Zlatko A1 - Gaita, Dan A1 - Gotcheva, Nina A1 - Goudevenos, John A1 - Heuschmann, Peter A1 - Laucevicius, Aleksandras A1 - Lehto, Seppo A1 - Lovic, Dragan A1 - Milicic, Davor A1 - Moore, David A1 - Nicolaides, Evagoras A1 - Oganov, Raphae A1 - Pajak, Andrzej A1 - Pogosova, Nana A1 - Reiner, Zeljko A1 - Stagmo, Martin A1 - Störk, Stefan A1 - Tokgözoglu, Lale A1 - Vulic, Dusko T1 - Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology JF - Cardiovascular Diabetology N2 - Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46 %) patients had no diabetes, 1158 (19 %) newly diagnosed diabetes and 2183 (35 %) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 %, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 % and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 %. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 % (53 mmol/mol) in 95 and 53 % and 11 % of those with previously known diabetes had an HbA1c >9.0 % (>75 mmol/mol). Of the patients with diabetes 69 % reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (approximate to 40 %) and only 27 % of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease. KW - heart KW - glycaemic control KW - cardiovascular diseases KW - myocardial infarction KW - glucose control KW - blood-glucose KW - risk factors KW - follow-up KW - mellitus KW - mortality KW - guidelines KW - coronary artery disease KW - type 2 diabetes KW - secondary prevention KW - management KW - guideline adherence KW - blood pressure KW - blood lipids Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-141358 VL - 14 IS - 133 ER - TY - JOUR A1 - Fruchart, Jean-Charles A1 - Davignon, Jean A1 - Hermans, Michael P. A1 - Al-Rubeaan, Khalid A1 - Amarenco, Pierre A1 - Assmann, Gerd A1 - Barter, Philip A1 - Betteridge, John A1 - Bruckert, Eric A1 - Cuevas, Ada A1 - Farnier, Michel A1 - Ferrannini, Ele A1 - Fioretto, Paola A1 - Genest, Jacques A1 - Ginsberg, Henry N. A1 - Gotto Jr., Antonio M. A1 - Hu, Dayi A1 - Kadowaki, Takashi A1 - Kodama, Tatsuhiko A1 - Krempf, Michel A1 - Matsuzawa, Yuji A1 - Núñez-Cortés, Jesús Millán A1 - Monfil, Calos Calvo A1 - Ogawa, Hisao A1 - Plutzky, Jorge A1 - Rader, Daniel J. A1 - Sadikot, Shaukat A1 - Santos, Raul D. A1 - Shlyakhto, Evgeny A1 - Sritara, Piyamitr A1 - Sy, Rody A1 - Tall, Alan A1 - Tan, Chee Eng A1 - Tokgözoğlu, Lale A1 - Toth, Peter P. A1 - Valensi, Paul A1 - Wanner, Christoph A1 - Zambon, Albertro A1 - Zhu, Junren A1 - Zimmet, Paul T1 - Residual macrovascular risk in 2013: what have we learned? JF - Cardiovascual Diabetology N2 - Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R(3)i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R(3)i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R(3)i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptor alpha agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R(3)i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk. KW - phospholipid fatty acids KW - term fenofibrate therapy KW - cardiovascular munster procam KW - residual cardiovascular risk KW - atherogenic dyslipidaemia KW - type 2 diabetes KW - therapeutic options KW - high denisty lipoprotein KW - randomized controlled-trial KW - coronary artery disease KW - type-2 diabetes mellitus KW - triglyceride-rich lipoproteins KW - alpha/delta agonist GFT505 KW - placebo-controlled trial Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-117546 SN - 1475-2840 VL - 13 IS - 26 ER - TY - THES A1 - Stein, Sylvia T1 - Hemmung der Mobilisation und Funktion humaner endothelialer Vorläuferzellen durch den endogenen NO-Synthase-Inhibitor asymmetrisches Dimethylarginin (ADMA) bei koronarer Herzkrankheit T1 - Suppression of endothelial progenitor cells in human coronary artery disease by the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine N2 - Intaktes Endothel und die ausreichende Funktion der endothelialen NO-Synthase (eNOS) sind Voraussetzungen für gesunde Gefäße. Eine endotheliale Dysfunktion besteht bei Patienten mit kardiovaskulären Risikofaktoren bzw. manifester koronarer Herzerkrankung (KHK). Endotheliale Vorläuferzellen (EPC) sind ein wichtiger Faktor für die Aufrechterhaltung der Homöostase des Endothels. Im klinischen Teil der vorliegenden Arbeit konnte gezeigt werden, dass diese Vorläuferzellen mit zunehmender Schwere der KHK in geringerem Maß im Blut zirkulieren. Die Anzahl der EPC war bei Patienten mit einer koronaren 3-Gefäßerkrankung um 77 % geringer, die Anzahl der kolonie-bildenden Einheiten (CFUs) um 50,3%, jeweils verglichen mit Patienten ohne KHK. Bei diesen Patienten konnte ebenfalls gezeigt werden, dass sich die Konzentration des endogenen eNOS-Inhibitors asymmetrisches Dimethylarginin (ADMA) im Plasma mit zunehmender Schwere der KHK erhöhte (0,47 ± 0,02 μmol/l bei fehlender KHK gegenüber 0,58 ± 0,02 μmol/l bei koronarer 3-Gefäßerkrankung). ADMA ist über eine Hemmung der eNOS an der Entstehung und Aufrechterhaltung einer endothelialen Dysfunktion beteiligt. Über diesen Weg wird vermutlich auch die Funktion der EPC erheblich eingeschränkt. Dies konnten wir anhand der In­vitro­Versuche mit EPC gesunder Spender zeigen. Dabei reduzierte sich unter ADMA-Einfluß die Anzahl der EPC in Kultur, die Anzahl und Größe der CFUs und ihre Funktion bzw. ihre Fähigkeit, sich in gefäßähnliche Strukturen zu integrieren. Eine gleichzeitige Gabe des HMG-CoA-Reduktase-Inhibitors Rosuvastatin wirkte in all diesen In-vitro-Versuchen der hemmenden Wirkung von ADMA entgegen. Die vorliegende Arbeit zeigt erstmals eine inverse Korrelation zwischen ADMA-Spiegeln und der Anzahl und Funktion der EPC. Der negative Einfluss auf EPCs ist vermutlich ein wichtiger Mechanismus, über den ADMA der Entstehung und dem Fortschreiten kardiovaskulärer Erkrankungen Vorschub leistet. N2 - Endothelial progenitor cells play a pivotal role in regeneration of injured endothelium, thereby limiting the formation of atherosclerotic lesions. Reduced numbers of EPCs may affect progression of coronary artery disease. Regulation of EPC mobilization and function is mediated in part by nitric oxide (NO). Endogenous inhibitors of NO synthases, such as ADMA, contribute to endothelial dysfunction and injury. We tested the hypothesis that asymmetric dimethylarginine (ADMA) may be an endogenous inhibitor of endothelial progenitor cells (EPCs). We used flow cytometry and in vitro assays to investigate the relationship between EPC number and function with ADMA plasma levels in patients with stable angina. The plasma concentration of ADMA was related to the severity of coronary artery disease and correlated inversely with the number of circulating CD34+/CD133+ progenitor cells (r = -0.69; p < 0.0001) and endothelial colony forming units (CFUs) (r = -0.75; p < 0.0001). Adjusting for all patient characteristics, we confirmed these findings in multivariate regression analyses. In vitro differentiation of EPCs was repressed by ADMA in a concentration-dependent manner. Compared with untreated cells, ADMA reduced EPC incorporation into endothelial tube-like structures to 27 +/- 11% (p < 0.001). Asymmetric dimethylarginine repressed the formation of CFUs from cultured peripheral blood mononuclear cells to 35 +/- 7% (p < 0.001). Asymmetric dimethylarginine decreased endothelial nitric oxide synthase activity in EPCs to 64 +/- 6% (p < 0.05) when compared with controls. Co-incubation with the hydroxymethyl glutaryl coenzyme A reductase inhibitor rosuvastatin abolished the detrimental effects of ADMA. CONCLUSIONS: Asymmetric dimethylarginine is an endogenous inhibitor of mobilization, differentiation, and function of EPCs. This contributes to the cardiovascular risk in patients with high ADMA levels and may explain low numbers and function of EPCs in patients with coronary artery disease. KW - endotheliale Vorläuferzellen KW - ADMA KW - NO-Synthase KW - asymmetrisches Dimethylarginin KW - koronare Herzkrankheit KW - asymmetric dimethylarginine KW - coronary artery disease KW - endothelial progenitor cells KW - nitric oxide synthase Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-57317 ER - TY - THES A1 - Kaufmann, Dana T1 - Neurologische Defizite bei Patienten mit der Diagnose KHK zu Beginn und am Ende der Anschlussheilbehandlung T1 - Kognitive decline under patients with coronary artery disease at the beginning and at the end of rebilitation N2 - Das Auftreten neurologischer Defizite bei Patienten mit der Diagnose Koronare Herzkrankheit (KHK) ist bekannt. Als Ursachen werden lange Ischämiezeiten und Mikroluftembolien (Bubbles) während einer Aorto-Koronaren-Venenbypass- Operation (ACVB-Operation) angenommen Patienten, die der kardiologischen Intervention mittels Perkutaner Transluminaler Koronarer Angioplastie (PTCA / PCI) zugeführt werden, zeigen ebenfalls neurologische Defizite. Bisher waren neurokognitive Veränderungen in der kardiologischen Rehabilitation nur Gegenstand sehr weniger Studien. Über den zeitlichen Verlauf während der Anschlussheilbehandlung (AHB) wurden noch keine Untersuchungen durchgeführt. Aus diesem Grund beschäftigt sich diese Arbeit mit der Testung des neurologischen Status der Patienten mit einer KHK bei Aufnahme und Entlassung aus der Rehabilitation. Es sollte geklärt werden, ob und in welchem Ausmaß kognitive Defizite bestehen und wie sich diese über den Zeitraum der Rehabilitation verändern. Dazu sieht die Studie einen Vergleich zwischen zwei Kohorten vor. Die erste Gruppe setzt sich aus Patienten zusammen, die mittels PTCA versorgt wurden. Die zweite Gruppe schließt einer ACVB-Operation zugeführte Herzpatienten ein. Dass KHK-Patienten neurokognitive Defizite aufweisen hat sich in den Studienergebnissen bestätigt. Sowohl die PCI-Kohorte, als auch die ACVB-Gruppe zeigte bei Aufnahme neurokognitive Leistungseinschränkungen in Form unterdurchschnittlicher Testergebnisse. Die Hypothese, dass im Rahmen einer AHB eine Verminderung neurokognitiver Leistungseinschränkungen und bessere Testresultate bei Entlassung erzielt werden, wurde widerlegt. Die Annahme, dass PCI-Patienten geringere kognitive Defizite und bessere Testleistungen bei Aufnahme und Entlassung verzeichnen als ACVB-Patienten trifft nicht zu. Die Vermutung, dass ACVB-Patienten ausgeprägtere neurologische Leistungseinschränkungen und schlechtere Testresultate bei Aufnahme und Entlassung aufzeigen, hat sich nicht bewahrheitet. N2 - The appearance of cognitive decline under patients with coronary artery disease is already known. Reasons are long ischemia and micro-aeroembolism during coronary artery bypass grafting. Patients treated by PCI also shown neurocognitive impairment. So far cognitive changes during rehabilitation were not evaluated in many surveys. There was no study concerning the time dependent change during cure. Because of this reason this study copes with testing the neurological status of patients with coronary artery disease at the beginning and at the end of rehabilitation. The survey should resolve the dimension and the time dependent change in term of rehabilitation. For that reason this survey includes a comparison between PCI and ACVB group. In result PCI as well as ACVB group were tetsted with bad cognitive accomplishment. In contrast, we disproved the hypothesis that neurocognitive decline improves during rehabilitation. The assumption that PCI patients show better test results than the ACVB patients couldn´t approved in this survey. KW - neurologische Defizite KW - KHK KW - ACVB KW - PTCA KW - Anschlussheilbehandlung KW - kognitive decline KW - coronary artery disease KW - CABG KW - PCI KW - rehabilitation Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-55153 ER - TY - THES A1 - Weinberger, Sarah T1 - Die konventionelle Plättchenaggregometrie unterschätzt das unzureichende Ansprechen auf Clopidogrel bei KHK-Patienten im Vergleich zu einem P2Y12-spezifischen Test T1 - ADP-induced platelet aggregation frequently fails to detect impaired clopidogrel-responsiveness in patients with coronary artery disease compared to a P2Y12-specific assay N2 - Die koronare Herzkrankheit ist die häufigste Todesursache in Industrienationen und wird mit Zunahme ihrer Risikofaktoren in Zukunft weiter an Bedeutung gewinnen. Seitdem große Studien zeigen konnten, dass KHK-Patienten von der Behandlung mit dem Thrombozytenaggregationshemmer Clopidogrel profitieren, ist das Thienopyridin Bestandteil der leitliniengerechten Therapie der akuten und chronischen KHK. In den letzten Jahren fanden Forscher jedoch heraus, dass individuelle Unterschiede in der Wirksamkeit von Clopidogrel existieren, die bei Nonrespondern mit einem erhöhten kardiovaskulären Risiko einhergehen. Zur Beurteilung der Relevanz eines verminderten Ansprechens auf Clopidogrel in einem alltäglichen Patientenkollektiv wurde aktuell die Thrombozytenaktivität von 100 konsekutiven Patienten mit stabiler KHK untersucht, die mit mindestens 75 mg Clopidogrel täglich behandelt wurden. Neben dem P2Y12-spezifischen PRI kam dazu auch die Messung der Verschlusszeit im PFA-100®, die ADP-induzierte P-Selektin-Expression und der aktuelle Goldstandard der Thrombozytenaktivitätsmessung, die ADP-induzierte Plättchenaggregometrie, zum Einsatz. Trotz guter Korrelation der Ergebnisse von PRI und Aggregometrie, war die Rate der Nonresponder mit einem PRI > 50% deutlich höher als in der Aggregometrie. Insgesamt fand sich bei 69% der Patienten ein unzureichendes Ansprechen auf Clopidogrel. 39% der Clopidogrel-Nonresponder konnten in der Aggregometrie nicht als solche detektiert werden. In der statistischen Analyse zeigten sich niedrige HDL-Spiegel und eine Hypercholesterinämie in der Vorgeschichte als Einflussfaktoren der Clopidogrel-Nonresponsiveness. Andere kardiovaskuläre Risikofaktoren, Komorbiditäten und Medikamente hatten keine Auswirkung auf die Clopidogrel-Responsiveness. Die Problematik der Clopidogrel-Nonresponsiveness bedarf vor allem wegen der Korrelation mit klinischen Ereignissen und der erhöhten Mortalität einer baldigen Lösung. In Frage kommen dazu der Einsatz neuer Substanzen und eine generelle oder individuelle Dosisanpassung. Unklar ist allerdings noch, welches Konzept am sichersten und ökonomischsten ist. Aktuell ist besonders bei Hochrisikopatienten eine Testung der Clopidogrel-Responsiveness mit individueller Dosisanpassung sinnvoll. Aufgrund der höheren Sensitivität im Vergleich zur Plättchenaggregometrie wäre ein P2Y12-spezifischer Test ähnlich dem PRI dazu am ehesten geeignet. N2 - Incomplete P2Y(12)-inhibition during clopidogrel treatment is associated with increased cardiovascular events and mortality after coronary intervention. We investigated the incidence of impaired individual clopidogrel-responsiveness using a P2Y(12)-specific and pre-treatment-independent assay in a real world situation. One hundred consecutive patients with coronary artery disease (CAD) on combined acetylsalicylic acid and clopidogrel treatment (75 mg/d) and 33 patients on aspirin only were screened for platelet ADP-induced signalling by conventional aggregometry, platelet P-selectin expression and the platelet reactivity index (PRI). Impaired P2Y(12)-specific inhibition by clopidogrel was defined as a PRI>50%. Functional platelet reactivity was significantly lower in clopidogrel-treated patients compared to controls. Impaired individual response to treatment was diagnosed in 69% of clopidogrel-treated patients. Conventional assessment of maximum ADP-induced platelet aggregation failed to detect impaired P2Y(12) inhibition in 36% of patients identified by PRI to have an impaired clopidogrel response. Impaired clopidogrel response was associated with lower HDL levels and a history of hyperlipidaemia. In conclusion, PRI as a P2Y(12)-specific assay to evaluate the treatment effect of clopidogrel in patients with CAD revealed insufficient P2Y(12)-inhibition in two thirds of patients in a real-world scenario indicating a markedly higher incidence than previously assumed. PRI detected significantly more patients with impaired response than conventional platelet aggregation. KW - Clopidogrel KW - Koronare Herzkrankheit KW - Stent KW - Clopidogrel KW - coronary artery disease KW - coronary stent Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-47824 ER - TY - THES A1 - Blümm, Annabelle T1 - Die klinische Wertigkeit von "High-Molecular-Weight" Adiponektin bei der Koronaren Herzkrankheit - Untersuchungen zur Rolle eines neuen kardiovaskulären Risikoprädiktors und dessen pharmakologischer Beeinflussung durch Atorvastatin T1 - Clinical value of high-molecular weight (HMW) adiponectin in coronary artery disease N2 - Adiponektin, ein Hormon des Fettgewebes, besitzt antiatherosklerotische Effekte und niedrige zirkulierende Adiponektin-Spiegel sind mit Koronarer Herzkrankheit (KHK) assoziiert. Der High-molecular weight (HMW)-Adiponektin Komplex wird als die bioaktive Komponente von Adiponektin vermutet. Frage dieser Studie war, ob HMW-Adiponektin mit dem Ausmaß einer KHK korreliert und ob HMW eher als Prädiktor für das Ausmaß einer KHK verwendet werden kann als Gesamtadiponektin. Eine weitere Studie zielte auf die mögliche therapeutische Beeinflussung der multimeren Zusammensetzung von Adiponektin mittels Atorvastatin. N2 - Adiponectin has anti-atherogenic properties and low circulating adiponectin has been linked to coronary atherosclerosis. There is considerable evidence that the high-molecular weight (HMW) complex of adiponectin is the major active form of this adipokine. We therefore investigated whether HMW adiponectin is associated with the extent of coronary disease (CAD) in men. In another study potential influences of atorvastatin therapy on adiponectin multimer distribution were studied in patient with type 2 diabetes. KW - Koronare Herzkrankheit KW - Atorvastatin KW - Hormon KW - Adiponektin KW - HMW-Adiponektin KW - Typ 2-Diabetes KW - coronary artery disease KW - diabetes KW - adiponectin KW - high molecular weight adiponectin Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-48143 ER -