TY  - THES
A1  - Werle, Philipp
T1  - Rolle von Mannose-binding Lectin für das ventrikuläre Remodeling nach Myokardinfarkt
T1  - The role of mannose-binding lectin in ventricular remodelling after myocardial infarction
N2  - Das aktivierte Komplementsystem, als Teil der angeborenen Immunantwort nach Myokardinfarkt, beeinflusst entscheidend das kardiale Remodeling. Mäuse, die für den Komplementfaktor C3 defizient waren, wiesen acht Wochen nach Infarkt eine signifikant geringere linksventrikuläre Dilatation auf. Anhand von MBL-KO Mäusen sollte in dieser Arbeit die Frage geklärt werden, inwieweit die Aktivierung des Komplementsystems im kardialen Remodeling auf den durch MBL eingeleiteten Pfad zurückgeht. Während sich bezüglich der Infarktgrößen, der Neutrophilen und des Kollagengehalts kein signifikanter Unterschied zwischen den beiden Gruppen zeigte, so wiesen die MBL-KO Tiere im Vergleich zu den WT Tieren eine signifikant größere ventrikuläre Dilatation auf. Basierend auf diesen Erkenntnissen kommen wir zu dem Schluss, dass sich die bezüglich der Ventrikelgröße positiven Effekte einer C3 Hemmung nicht mit einer MBL Hemmung in Einklang bringen lassen. Die dauerhafte Aktivierung des Komplementsystems während des ventrikulären Remodelings, beruht angesichts der Aggravierung der linksventrikulären Dilatation nicht auf dem MBL-Weg.
N2  - The complement system, as an important part of the activated innate immune system after myocardial infarction, influences the remodelling process. Complement factor C3-KO mice showed 8 weeks after infarction significant less ventricular dilatation than WT-mice. Here, we examined whether activation of the complement system in cardiac remodelling could be ascribed to the MBL pathway. However, 8 weeks after infarction MBL-KO mice showed a significant increase in ventricular dilatation compared to the WT-mice of the control group. The positive effects seen in C3-KO mice couldn’t be found in MBL-KO mice. Thus the activation of the complement system in ventricular remodelling is not related to the MBL-pathway.
KW  - Chronische Herzinsuffizienz
KW  - Komplement <Immunologie>
KW  - Herzinfarkt
KW  - myocardial infarction
KW  - heart failure
KW  - complement system
Y1  - 2010
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-55521
ER  - 
TY  - JOUR
A1  - Traub, Jan
A1  - Otto, Markus
A1  - Sell, Roxane
A1  - Göpfert, Dennis
A1  - Homola, György
A1  - Steinacker, Petra
A1  - Oeckl, Patrick
A1  - Morbach, Caroline
A1  - Frantz, Stefan
A1  - Pham, Mirko
A1  - Störk, Stefan
A1  - Stoll, Guido
A1  - Frey, Anna
T1  - Serum phosphorylated tau protein 181 and neurofilament light chain in cognitively impaired heart failure patients
JF  - Alzheimer's Research & Therapy
N2  - Background
Chronic heart failure (HF) is known to increase the risk of developing Alzheimer’s dementia significantly. Thus, detecting and preventing mild cognitive impairment, which is common in patients with HF, is of great importance. Serum biomarkers are increasingly used in neurological disorders for diagnostics, monitoring, and prognostication of disease course. It remains unclear if neuronal biomarkers may help detect cognitive impairment in this high-risk population. Also, the influence of chronic HF and concomitant renal dysfunction on these biomarkers is not well understood.

Methods
Within the monocentric Cognition.Matters-HF study, we quantified the serum levels of phosphorylated tau protein 181 (pTau) and neurofilament light chain (NfL) of 146 extensively phenotyped chronic heart failure patients (aged 32 to 85 years; 15.1% women) using ultrasensitive bead-based single-molecule immunoassays. The clinical work-up included advanced cognitive testing and cerebral magnetic resonance imaging (MRI).

Results
Serum concentrations of NfL ranged from 5.4 to 215.0 pg/ml (median 26.4 pg/ml) and of pTau from 0.51 to 9.22 pg/ml (median 1.57 pg/ml). We detected mild cognitive impairment (i.e., T-score < 40 in at least one cognitive domain) in 60% of heart failure patients. pTau (p = 0.014), but not NfL, was elevated in this group. Both NfL (ρ = − 0.21; p = 0.013) and pTau (ρ = − 0.25; p = 0.002) related to the cognitive domain visual/verbal memory, as well as white matter hyperintensity volume and cerebral and hippocampal atrophy. In multivariable analysis, both biomarkers were independently influenced by age (T = 4.6 for pTau; T = 5.9 for NfL) and glomerular filtration rate (T = − 2.4 for pTau; T = − 3.4 for NfL). Markers of chronic heart failure, left atrial volume index (T = 4.6) and NT-proBNP (T = 2.8), were further cardiological determinants of pTau and NfL, respectively. In addition, pTau was also strongly affected by serum creatine kinase levels (T = 6.5) and ferritin (T = − 3.1).

Conclusions
pTau and NfL serum levels are strongly influenced by age-dependent renal and cardiac dysfunction. These findings point towards the need for longitudinal examinations and consideration of frequent comorbidities when using neuronal serum biomarkers.
KW  - Alzheimer’s dementia
KW  - heart failure
KW  - cognitive impairment
KW  - neurofilament light chain
KW  - phosphorylated tau protein
KW  - renal function
KW  - age
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300515
VL  - 14
ER  - 
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  - Störk, Stefan
A1  - Bernhardt, Alexandra
A1  - Böhm, Michael
A1  - Brachmann, Johannes
A1  - Dagres, Nikolaos
A1  - Frantz, Stefan
A1  - Hindricks, Gerd
A1  - Köhler, Friedrich
A1  - Zeymer, Uwe
A1  - Rosenkranz, Stephan
A1  - Angermann, Christiane
A1  - Aßmus, Birgit
T1  - Pulmonary artery sensor system pressure monitoring to improve heart failure outcomes (PASSPORT-HF): rationale and design of the PASSPORT-HF multicenter randomized clinical trial
JF  - Clinical Research in Cardiology
N2  - Background
Remote monitoring of patients with New York Heart Association (NYHA) functional class III heart failure (HF) using daily transmission of pulmonary artery (PA) pressure values has shown a reduction in HF-related hospitalizations and improved quality of life in patients.

Objectives
PASSPORT-HF is a prospective, randomized, open, multicenter trial evaluating the effects of a hemodynamic-guided, HF nurse-led care approach using the CardioMEMS™ HF-System on clinical end points.

Methods and results
The PASSPORT-HF trial has been commissioned by the German Federal Joint Committee (G-BA) to ascertain the efficacy of PA pressure-guided remote care in the German health-care system. PASSPORT-HF includes adult HF patients in NYHA functional class III, who experienced an HF-related hospitalization within the last 12 months. Patients with reduced ejection fraction must be on stable guideline-directed pharmacotherapy. Patients will be randomized centrally 1:1 to implantation of a CardioMEMS™ sensor or control. All patients will receive post-discharge support facilitated by trained HF nurses providing structured telephone-based care. The trial will enroll 554 patients at about 50 study sites. The primary end point is a composite of the number of unplanned HF-related rehospitalizations or all-cause death after 12 months of follow-up, and all events will be adjudicated centrally. Secondary end points include device/system-related complications, components of the primary end point, days alive and out of hospital, disease-specific and generic health-related quality of life including their sub-scales, and laboratory parameters of organ damage and disease progression.

Conclusions
PASSPORT-HF will define the efficacy of implementing hemodynamic monitoring as a novel disease management tool in routine outpatient care.

Trial registration
ClinicalTrials.gov; NCT04398654, 13-MAY-2020.
KW  - heart failure
KW  - pulmonary artery pressure
KW  - remote monitoring
KW  - CardioMEMS™ HF-System
KW  - randomized controlled trial
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324026
VL  - 111
IS  - 11
ER  - 
TY  - JOUR
A1  - Steinhardt, Maximilian J.
A1  - Cejka, Vladimir
A1  - Chen, Mengmeng
A1  - Bäuerlein, Sabrina
A1  - Schäfer, Julia
A1  - Adrah, Ali
A1  - Ihne-Schubert, Sandra M.
A1  - Papagianni, Aikaterini
A1  - Kortüm, K. Martin
A1  - Morbach, Caroline
A1  - Störk, Stefan
T1  - Safety and tolerability of SGLT2 inhibitors in cardiac amyloidosis — a clinical feasibility study
JF  - Journal of Clinical Medicine
N2  - Sodium-glucose transport protein 2 inhibitors (SGLT2i) slow the progression of renal dysfunction and improve the prognosis of patients with heart failure. Amyloidosis constitutes an important subgroup for which evidence is lacking. Amyloidotic fibrils originating from misfolded transthyretin and light chains are the causal agents in ATTR and AL amyloidosis. In these most frequent subtypes, cardiac involvement is the most common organ manifestation. Because cardiac and renal function frequently deteriorate over time, even under best available treatment, SGLT2i emerge as a promising treatment option due to their reno- and cardioprotective properties. We retrospectively analyzed patients with cardiac amyloidosis, who received either dapagliflozin or empagliflozin. Out of 79 patients, 5.1% had urinary tract infections; 2 stopped SGLT2i therapy; and 2.5% died unrelated to the intake of SGLT2i. No genital mycotic infections were observed. As expected, a slight drop in the glomerular filtration rate was noted, while the NYHA functional status, cardiac and hepatic function, as well as the 6 min walk distance remained stable over time. These data provide a rationale for the use of SGLT2i in patients with amyloidosis and concomitant cardiac or renal dysfunction. Prospective randomized data are desired to confirm safety and to prove efficacy in this increasingly important group of patients.
KW  - heart failure
KW  - chronic kidney disease
KW  - amyloidosis
KW  - SGLT2 inhibitors
Y1  - 2024
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-356024
SN  - 2077-0383
VL  - 13
IS  - 1
ER  - 
TY  - JOUR
A1  - Sommer, Kim K.
A1  - Amr, Ali
A1  - Bavendiek, Udo
A1  - Beierle, Felix
A1  - Brunecker, Peter
A1  - Dathe, Henning
A1  - Eils, Jürgen
A1  - Ertl, Maximilian
A1  - Fette, Georg
A1  - Gietzelt, Matthias
A1  - Heidecker, Bettina
A1  - Hellenkamp, Kristian
A1  - Heuschmann, Peter
A1  - Hoos, Jennifer D. E.
A1  - Kesztyüs, Tibor
A1  - Kerwagen, Fabian
A1  - Kindermann, Aljoscha
A1  - Krefting, Dagmar
A1  - Landmesser, Ulf
A1  - Marschollek, Michael
A1  - Meder, Benjamin
A1  - Merzweiler, Angela
A1  - Prasser, Fabian
A1  - Pryss, Rüdiger
A1  - Richter, Jendrik
A1  - Schneider, Philipp
A1  - Störk, Stefan
A1  - Dieterich, Christoph
T1  - Structured, harmonized, and interoperable integration of clinical routine data to compute heart failure risk scores
JF  - Life
N2  - Risk prediction in patients with heart failure (HF) is essential to improve the tailoring of preventive, diagnostic, and therapeutic strategies for the individual patient, and effectively use health care resources. Risk scores derived from controlled clinical studies can be used to calculate the risk of mortality and HF hospitalizations. However, these scores are poorly implemented into routine care, predominantly because their calculation requires considerable efforts in practice and necessary data often are not available in an interoperable format. In this work, we demonstrate the feasibility of a multi-site solution to derive and calculate two exemplary HF scores from clinical routine data (MAGGIC score with six continuous and eight categorical variables; Barcelona Bio-HF score with five continuous and six categorical variables). Within HiGHmed, a German Medical Informatics Initiative consortium, we implemented an interoperable solution, collecting a harmonized HF-phenotypic core data set (CDS) within the openEHR framework. Our approach minimizes the need for manual data entry by automatically retrieving data from primary systems. We show, across five participating medical centers, that the implemented structures to execute dedicated data queries, followed by harmonized data processing and score calculation, work well in practice. In summary, we demonstrated the feasibility of clinical routine data usage across multiple partner sites to compute HF risk scores. This solution can be extended to a large spectrum of applications in clinical care.
KW  - medical informatics initiative
KW  - HiGHmed
KW  - medical data integration center
KW  - clinical routine data
KW  - heart failure
KW  - risk prediction scores
KW  - semantic interoperability
KW  - openEHR
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-275239
SN  - 2075-1729
VL  - 12
IS  - 5
ER  - 
TY  - THES
A1  - Schöpp, Corinna
T1  - Die Wirkung von Fractalkine auf Thrombozytenaktivierung und Endotheldysfunktion bei Herzinsuffizienz und Diabetes
T1  - Influence of fractalkine on platelet activation and endothelial dysfunction in heart failure and diabetes
N2  - Diabetes mellitus und Herzinsuffizienz gehen mit einer stark erhöhten kardiovaskulären Morbidität einher. Bei beiden Krankheiten besteht eine Endotheldysfunktion und eine verstärkte Thrombozytenaktivierung. Daraus resultieren wiederum frühe atherosklerotische Läsionen bzw. eine Progression der Herzinsuffizienz. Das Chemokin Fractalkine wurde als Risikofaktor für eine schwere koronare Herzerkrankung beschrieben. Der Fractalkine-Rezeptor ist mit einem erhöhten Atherosklerose-Risiko assoziiert. Auch ist Fractalkine in der Lage, eine Endotheldysfunktion sowie eine Thrombozytenaktivierung zu induzieren bzw. zu verstärken. Es lag daher nahe, den Effekt von Fractalkine auf Endothel und Thrombozyten von Ratten mit Herzinsuffizienz und Diabetes mellitus zu untersuchen. Die Expression von Fractalkine wie auch seines Rezeptors war in der Aorta bei Herzinsuffizienz und Diabetes mellitus gesteigert. Auch das lösliche Fractalkine im Serum war bei beiden Krankheitsmodellen erhöht. Auf der Thrombozytenoberfläche zeigte sich eine stärkere Fractalkine-Rezeptor-Expression. Durch Stimulation mit Fractalkine konnte bei beiden Modellen eine signifikant akzelerierte Thrombozytenaktivierung erzielt werden. Bei den herzinsuffizienten Tieren zeigte sich eine signifikante Verschlechterung der schon bestehenden endothelialen Dysfunktion nach Inkubation mit Fractalkine. Deshalb kann man davon ausgehen, dass Fractalkine eine bedeutende Rolle sowohl für die Atherosklerose bei Diabetes mellitus als auch bei Herzinsuffizienz spielt. Man könnte sich nun Fractalkine und seinen Rezeptor als einen neuen therapeutischen Ansatzpunkt für die Verhinderung der Progression sowohl atherosklerotischer Läsionen als auch der Inflammation bei Herzinsuffizienz vorstellen. Dadurch wäre eine Reduzierung weiterer atherosklerotischer Komplikationen wie Myokardinfarkt oder Schlaganfall eventuell möglich.
N2  - Diabetes mellitus and congestive heart failure are associated with increased cardiovascular morbidity and mortality. Both diseases display endothelial dysfunction and increased platelet activation resulting in early atherosclerotic lesion development or progression of heart failure. The chemokine fractalkine has been described as a risk factor for severe coronary artery disease. The fractalkine-receptor is associated with enhanced probability for atherosclerosis. Furthermore, fractalkine is able to induce endothelial dysfunction and to aggravate platelet activiation. Therefore, the effect of fractalkine on endothelium and platelets was investigated in rats with heart failure and diabetes mellitus. The expression of fractalkine itself as well as of its receptor was increased in rat aorta during heart failure and diabetes. Although, soluble fractalkine serum levels were increased in both disease models. Fractalkine-receptor expression on the platelet surface was strongly enhanced in both models. Stimulating platelets from these disease models with fractalkine resulted in significant enhancement of platelet activation. In animals with congestive heart failure, incubation with fractalkine induced a significant deterioration of the preexisting endothelial dysfunction. Therefore, it has to be assumed, that fractalkine is a central regulator for atherosclerosis in diabetes and in heart failure. Fractalkine as well as its receptor might be useful as a novel therapeutic target to prevent atherosclerotic lesion progression in diabetes or inflammation in heart failure. This could potentially further reduce atherosclerotic complications such as myocardial infarction or stroke.
KW  - Arteriosklerose
KW  - Fractalkine
KW  - Herzinsuffizienz
KW  - Diabetes mellitus
KW  - Endotheldysfunktion
KW  - Thrombozytenaktivierung
KW  - Fractalkine
KW  - heart failure
KW  - diabetes melitus
KW  - endothelial dysfunction
KW  - platelet activation
Y1  - 2009
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-43371
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  - Montellano, Felipe A.
A1  - Kluter, Elisabeth J.
A1  - Rücker, Viktoria
A1  - Ungethüm, Kathrin
A1  - Mackenrodt, Daniel
A1  - Wiedmann, Silke
A1  - Dege, Tassilo
A1  - Quilitzsch, Anika
A1  - Morbach, Caroline
A1  - Frantz, Stefan
A1  - Störk, Stefan
A1  - Haeusler, Karl Georg
A1  - Kleinschnitz, Christoph
A1  - Heuschmann, Peter U.
T1  - Cardiac dysfunction and high-sensitive C-reactive protein are associated with troponin T elevation in ischemic stroke: insights from the SICFAIL study
JF  - BMC Neurology
N2  - Background
Troponin elevation is common in ischemic stroke (IS) patients. The pathomechanisms involved are incompletely understood and comprise coronary and non-coronary causes, e.g. autonomic dysfunction. We investigated determinants of troponin elevation in acute IS patients including markers of autonomic dysfunction, assessed by heart rate variability (HRV) time domain variables.
Methods
Data were collected within the Stroke Induced Cardiac FAILure (SICFAIL) cohort study. IS patients admitted to the Department of Neurology, Würzburg University Hospital, underwent baseline investigation including cardiac history, physical examination, echocardiography, and blood sampling. Four HRV time domain variables were calculated in patients undergoing electrocardiographic Holter monitoring. Multivariable logistic regression with corresponding odds ratios (OR) and 95% confidence intervals (CI) was used to investigate the determinants of high-sensitive troponin T (hs-TnT) levels ≥14 ng/L.
Results
We report results from 543 IS patients recruited between 01/2014–02/2017. Of those, 203 (37%) had hs-TnT ≥14 ng/L, which was independently associated with older age (OR per year 1.05; 95% CI 1.02–1.08), male sex (OR 2.65; 95% CI 1.54–4.58), decreasing estimated glomerular filtration rate (OR per 10 mL/min/1.73 m2 0.71; 95% CI 0.61–0.84), systolic dysfunction (OR 2.79; 95% CI 1.22–6.37), diastolic dysfunction (OR 2.29; 95% CI 1.29–4.02), atrial fibrillation (OR 2.30; 95% CI 1.25–4.23), and increasing levels of C-reactive protein (OR 1.48 per log unit; 95% CI 1.22–1.79). We did not identify an independent association of troponin elevation with the investigated HRV variables.
Conclusion
Cardiac dysfunction and elevated C-reactive protein, but not a reduced HRV as surrogate of autonomic dysfunction, were associated with increased hs-TnT levels in IS patients independent of established cardiovascular risk factors.
KW  - echocardiography
KW  - ischemic stroke
KW  - troponin
KW  - heart failure
KW  - biomarkers
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300119
VL  - 22
IS  - 1
ER  - 
TY  - THES
A1  - Lau, Kolja
T1  - Diastolische Herzfunktion und ihre Vorhersagekraft auf das Langzeitüberleben bei HerzinsuffizienzpatientInnen mit mittelgradiger oder reduzierter linksventrikulärer Ejektionsfraktion
T1  - Impact of diastolic dysfunction on outcome in heart failure patients with mid-range or reduced ejection fraction
N2  - Diese retrospektive Auswertung von PatientInnendaten der kardiologischen Ambulanz des Universitätsklinikums Würzburg konnte zeigen, dass die Bestimmung der diastolischen Dysfunktion prognostisch relevante Informationen enthält. Das Studienkollektiv wurde anhand der gemessenen Ejektionsfraktion in die zwei Untersuchungsgruppen HFrEF und HFmrEF eingeteilt. Diese zwei Untersuchungsgruppen wurden anhand ihrer klinisch und echokardiographisch bestimmten Charakteristika verglichen. Anschließend wurden drei diastolische Parameter (E/e’, LAVi und TRVmax) auf ihre prognostische Relevanz untersucht. Die abschließende Untersuchung gruppierte die PatientInnen anhand der Schwere ihrer diastolischen Dysfunktion (mild / moderat / schwer) und untersuchte ebenfalls das Langzeitüberleben.

Die HFmrEF-Gruppe zeigte ähnliche klinische Charakteristika wie die HFrEF-Gruppe. Eine ischämische Genese der Herzinsuffizienz wurde in der HFmrEF-Gruppe im Vergleich zur HFrEF-Gruppe häufiger beobachtet.
Die Überlebenszeitanalysen konnten bei PatientInnen in der HFmrEF-Gruppe zeigen, dass ein dilatierter linker Vorhof (LAVi) oder eine große Regurgitation über der Trikuspidalklappe (TRVmax) mit einer schlechten Prognose einhergehen. Bei HFrEF-PatientInnen hingegen konnte dies nicht nachgewiesen werden. Hier zeigte sich, dass insbesondere der Parameter E/e’septal prognostisch relevante Informationen enthält.
Die Auswertung der Untersuchungsgruppen nach Einteilung anhand der Schwere der diastolischen Dysfunktion konnte die gefunden Effekte bestätigen. Eine moderate bis schwere diastolische Dysfunktion war mit einer signifikant schlechteren Prognose behaftet, und zwar sowohl in der HFrEF- wie auch in der HFmrEF-Gruppe.

Die gefunden Ergebnisse zeigen, dass die diastolische Dysfunktion auch bei PatientInnen mit einer systolischen Herzinsuffizienz wichtige prognostische Informationen enthalten. In der klinischen Routine sollte die echokardiographische Bestimmung der diastolischen Herzfunktion standardmäßig durchgeführt werden.
Die Ergebnisse könnten nicht nur in der Diagnostik zur Kategorisierung der PatientInnen und Bestimmung der Prognose, sondern auch hinsichtlich der Therapie von großem zukünftigem Nutzen sein. Hierzu sollten perspektivisch vor allem therapeutische Aspekte in prospektiven, idealerweise randomisierten Studien untersucht werden, welche sich auf die Erkenntnisse dieser Arbeit beziehen.
N2  - This study evaluated the echocardiographic measured diastolic dysfunction in heart failure patients with mid-range or reduced left ventricular ejection fraction.
Conclusions:
We could demonstrate, that moderate to severe diastolic dysfunction identified by echocardiography is significantly associated with all-cause mortality both in patients with HFrEF and HFmrEF. Septal E/E' ratio serves es an independent determinant of all-cause mortality in patients with HFrEF but not in patients with HFmrEF. LAVi and TRVmax could be useful as an independent determinant of all-cause mortality in patients with HFmrEF.
KW  - Herzinsuffizienz
KW  - Transthorakale Echokardiographie
KW  - heart failure
KW  - HFrEF
KW  - HFmrEF
KW  - diagnostic
KW  - prognostic
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241704
ER  -