Refine
Has Fulltext
- yes (56)
Is part of the Bibliography
- yes (56)
Year of publication
Document Type
- Journal article (56)
Language
- English (56) (remove)
Keywords
- heart failure (13)
- mortality (5)
- echocardiography (4)
- myocardial infarction (4)
- amyloidosis (3)
- chronic kidney disease (3)
- cognitive impairment (3)
- coronary artery disease (3)
- ejection fraction (3)
- guideline adherence (3)
- hypertension (3)
- prognosis (3)
- GFAP (2)
- acute heart failure (2)
- anxiety (2)
- cardiac magnetic resonance imaging (2)
- cardiac surgery (2)
- cardiomyopathy (2)
- coronary heart disease (2)
- deformation (2)
- depression (2)
- diagnosis (2)
- glial fibrillary acidic protein (2)
- guidelines (2)
- ischemic stroke (2)
- left ventricular ejection fraction (2)
- management (2)
- myocardial work (2)
- neurofilament light chain (2)
- prevalence (2)
- quality of life (2)
- validation (2)
- 2-dimensional speckle tracking (1)
- ACC/AHA classification (1)
- AKI (1)
- Akutes Nierenversagen (1)
- Alzheimer's disease (1)
- Alzheimer’s dementia (1)
- BDNF (1)
- Brain atrophy (1)
- COMT (1)
- COPD diagnosis (1)
- COVID-19 (1)
- Cardiac dysfunction| Brain natriuretic peptide (1)
- CardioMEMS™ HF-System (1)
- Cardiovascular magnetic-resonance (1)
- Cardiovascular risk factors (1)
- Cardiovascular risk prediction (1)
- Carotid intima-media thickness (CIMT) (1)
- Carotid segment (1)
- Carotid ultrasound (1)
- Chronic heart failure (1)
- Cognitive decline (1)
- Coronary artery disease (1)
- Diastocic Dysfunction (1)
- ESC (1)
- EUROASPIRE survey (1)
- Enzyme replacement therapy (1)
- Eplerenone (1)
- Framingham (1)
- GDNF (1)
- GOLD (1)
- Glial fibrillary acidic protein (1)
- Guidelines (1)
- Heart failure (1)
- HiGHmed (1)
- Hyperkalemia (1)
- Hypertrophic cardiomyopathy (1)
- ICD-coding of CKD (1)
- Internet of Things devices (1)
- KDIGO (1)
- LV dilatation (1)
- MRI (1)
- Management (1)
- Manifestation (1)
- Medizin (1)
- Memory dysfunction (1)
- Morbidity (1)
- Mortality (1)
- Myocardial fibrosis (1)
- Myocardial-Infarction (1)
- NT‐proBNP (1)
- NfL (1)
- Outcomes (1)
- Predictors (1)
- Preserved Ejection Fraction (1)
- SGLT2 inhibitors (1)
- ST-elevation myocardial infarction (1)
- STEMI (1)
- Septal bulge (1)
- Stroke (1)
- Task force (1)
- Troponin (1)
- Ventricular-arrhythmias (1)
- accuracy (1)
- acute decompensated heart failure (1)
- acute kidney injury (1)
- adaptive immune response (1)
- age (1)
- age-related hearing loss (1)
- amyloid cardiomyopathy (1)
- anaemia (1)
- anti-myocardial (1)
- aortic valve stenosis (1)
- arterial stiffening (1)
- atherosclerosis (1)
- atrial fibrillation (1)
- autoantibody (1)
- awareness (1)
- biomarker (1)
- biomarkers (1)
- blood coagulation factor XIII (1)
- blood lipids (1)
- blood pressure (1)
- blood pressure monitoring (1)
- blood-glucose (1)
- blood–brain barrier (1)
- blood–labyrinth barrier (1)
- bull’s eye plot (1)
- calcification (1)
- calcium imaging (1)
- cardiac arrest (1)
- cardiac training group (1)
- cardiac transplantation (1)
- cardiopulmonary bypass (1)
- cardiovascular care (1)
- cardiovascular diseases (1)
- cardiovascular magnetic resonance (1)
- cardiovascular risk factors (1)
- carotid artery disease (1)
- chronic heart failure (1)
- chronic heart failure (CHF) (1)
- chronic thromboembolic pulmonary hypertension (1)
- clinical data warehouse (1)
- clinical manifestations (1)
- clinical routine data (1)
- clinical study (1)
- clinical systems (1)
- cluster analysis (1)
- coaptation line (1)
- comorbidity (1)
- comparability (1)
- congestion (1)
- data warehouse (1)
- death rates (1)
- dementia (1)
- diagnostic medicine (1)
- digital Health (1)
- digital phenotyping (1)
- disease (1)
- disease score (1)
- disease severity (1)
- dynamic (1)
- ecological momentary assessment (1)
- electronic data capture (1)
- electronic health records (1)
- euroaspire (1)
- evidence-based practice (1)
- fabry disease (1)
- feasibility (1)
- fibrosis (1)
- follow-up (1)
- functional regurgitation (1)
- glial damage (1)
- glucose control (1)
- glycaemic control (1)
- guideline implementation (1)
- guideline-directed medical therapy (1)
- healing and remodelling processes (1)
- health care research (1)
- health economics (1)
- health policy (1)
- health questionnaire (1)
- health risk assessment (1)
- heart (1)
- heart disease (1)
- heart failure training group (1)
- heart rate variability (1)
- heme oxygenase-1 (1)
- home telemonitoring (1)
- hospitalization (1)
- human behaviour (1)
- identification (1)
- impact (1)
- incremental cost-effectiveness ratio (ICER) (1)
- infarction size (1)
- inferior vena cava (1)
- inflammation (1)
- information extraction (1)
- intensity of attention (1)
- internal medicine (1)
- ischemic (1)
- leaflet (1)
- left ventricular geometric abnormality (1)
- left ventricular geometry (1)
- left ventricular hypertrophy (1)
- left ventricular mass (1)
- left ventricular performance (1)
- left ventricular remodeling (1)
- longitudinal studies (1)
- lower limit of normal (1)
- m exercise training (1)
- mHealth (1)
- medical data integration center (1)
- medical informatics initiative (1)
- medication extraction (1)
- mellitus (1)
- metaanalysis (1)
- mineralocorticoid antagonist (1)
- mitral valve (1)
- mobile crowdsensing (1)
- mobile health (1)
- morbidity (1)
- motion detector (1)
- music performance anxiety (1)
- myocardial work efficiency (1)
- myocardial fibrosis (1)
- natriuretic peptide (1)
- neuroinflammation (1)
- neurotrophins (1)
- noncontact monitoring (1)
- normal values (1)
- observational study (1)
- oncology (1)
- openEHR (1)
- outcomes (1)
- patients’ awareness (1)
- pharmacotherapy (1)
- phosphorylated tau protein (1)
- physicians’ awareness (1)
- point-of-care echocardiography (1)
- population (1)
- population-based study (1)
- postoperativ (1)
- preserved ejection fraction (1)
- primary prevention (1)
- progressive muscle relaxation (1)
- pulmonary artery pressure (1)
- randomized controlled trial (1)
- real-world (1)
- recovery (1)
- reference data (1)
- regression analysis (1)
- remote monitoring (1)
- renal function (1)
- risk factor control (1)
- risk factors (1)
- risk prediction scores (1)
- sacubitril-valsartan (1)
- scale (1)
- secondary data usage (1)
- secondary prevention (1)
- semantic interoperability (1)
- sex differences (1)
- sodium-glucose co-transporter-2 inhibitors (1)
- speckle tracking imaging (1)
- speech recognition (1)
- spiral ganglion neuron (1)
- standardization (1)
- stem cell transplantation (1)
- stroke unit (1)
- systolic dysfunction (1)
- task force (1)
- telemedicine (1)
- tenting (1)
- therapeutic approach (1)
- therapy (1)
- three-dimensional echocardiography (1)
- treatment (1)
- tricuspid pressure gradient (1)
- troponin (1)
- troponin T (1)
- type 2 diabetes (1)
- ultrasound (1)
- usability (1)
- user-centered design (1)
- validity (1)
- virtual reality exposure therapy (1)
Institute
- Medizinische Klinik und Poliklinik I (48)
- Deutsches Zentrum für Herzinsuffizienz (DZHI) (30)
- Institut für Klinische Epidemiologie und Biometrie (18)
- Neurologische Klinik und Poliklinik (7)
- Institut für Informatik (6)
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie (6)
- Klinik und Poliklinik für Thorax-, Herz- u. Thorakale Gefäßchirurgie (6)
- Medizinische Klinik und Poliklinik II (5)
- Institut für diagnostische und interventionelle Radiologie (Institut für Röntgendiagnostik) (4)
- Institut für Virologie und Immunbiologie (3)
Sonstige beteiligte Institutionen
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.
Aims
Cognitive dysfunction occurs frequently in patients with heart failure (HF), but early detection remains challenging. Serum glial fibrillary acidic protein (GFAP) is an emerging biomarker of cognitive decline in disorders of primary neurodegeneration such as Alzheimer's disease. We evaluated the utility of serum GFAP as a biomarker for cognitive dysfunction and structural brain damage in patients with stable chronic HF.
Methods and results
Using bead-based single molecule immunoassays, we quantified serum levels of GFAP in patients with HF participating in the prospective Cognition.Matters-HF study. Participants were extensively phenotyped, including cognitive testing of five separate domains and magnetic resonance imaging (MRI) of the brain. Univariable and multivariable models, also accounting for multiple testing, were run. One hundred and forty-six chronic HF patients with a mean age of 63.8 ± 10.8 years were included (15.1% women). Serum GFAP levels (median 246 pg/mL, quartiles 165, 384 pg/mL; range 66 to 1512 pg/mL) did not differ between sexes. In the multivariable adjusted model, independent predictors of GFAP levels were age (T = 5.5; P < 0.001), smoking (T = 3.2; P = 0.002), estimated glomerular filtration rate (T = −4.7; P < 0.001), alanine aminotransferase (T = −2.1; P = 0.036), and the left atrial end-systolic volume index (T = 3.4; P = 0.004). NT-proBNP but not serum GFAP explained global cerebral atrophy beyond ageing. However, serum GFAP levels were associated with the cognitive domain visual/verbal memory (T = −3.0; P = 0.003) along with focal hippocampal atrophy (T = 2.3; P = 0.025).
Conclusions
Serum GFAP levels are affected by age, smoking, and surrogates of the severity of HF. The association of GFAP with memory dysfunction suggests that astroglial pathologies, which evade detection by conventional MRI, may contribute to memory loss beyond ageing in patients with chronic HF.
Background
Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician’s awareness of kidney disease of patients hospitalized for CHD and also the patient’s awareness of CKD in a study visit following hospital discharge.
Methods
All serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFR\(_{CKD-EPI}\) < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician’s awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician.
Results
Of the 536 patients, 32% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22%, and 72% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35% had impaired kidney function. Of 158 patients with kidney disease, 54 (34%) were aware of CKD. Determinants of patient’s awareness were severity of CKD (OR\(_{eGFR}\) 0.94; 95%CI 0.92–0.96), obesity (OR 1.97; 1.07–3.64), history of heart failure (OR 1.99; 1.00–3.97), and mentioning of kidney disease in the index event’s hospital discharge letter (OR 5.51; 2.35–12.9).
Conclusions
Although CKD is frequent in CHD, only one third of patients is aware of this condition. Patient’s awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician’s awareness for kidney dysfunction may improve patient’s awareness of CKD.
Patients with genetic cardiomyopathy that involves myocardial hypertrophy often develop clinically relevant arrhythmias that increase the risk of sudden death. Consequently, guidelines for medical device therapy were established for hypertrophic cardiomyopathy, but not for conditions with only anecdotal evidence of arrhythmias, like Fabry cardiomyopathy. Patients with Fabry cardiomyopathy progressively develop myocardial fibrosis, and sudden cardiac death occurs regularly. Because 24-hour Holier electrocardiograms (ECGs) might not detect clinically important arrhythmias, we tested an implanted loop recorder for continuous heart rhythm surveillance and determined its impact on therapy. This prospective study included 16 patients (12 men) with advanced Fabry cardiomyopathy, relevant hypertrophy, and replacement fibrosis in "loco typico." No patients previously exhibited clinically relevant arrhythmias on Holier ECGs. Patients received an implantable loop recorder and were prospectively followed with telemedicine for a median of 1.2 years (range 0.3 to 2.0 years). The primary end point was a clinically meaningful event, which required a therapy change, captured with the loop recorder. Patients submitted data regularly (14 +/- 11 times per month). During follow-up, 21 events were detected (including 4 asystole, i.e., ECG pauses >= 3 seconds) and 7 bradycardia events; 5 episodes of intermittent atrial fibrillation (>3 minutes) and 5 episodes of ventricular tachycardia (3 sustained and 2 nonsustained). Subsequently, as defined in the primary end point, 15 events leaded to a change of therapy. These patients required therapy with a pacemaker or cardioverter defibrillator implantation and/or anticoagulation therapy for atrial fibrillation. In conclusion, clinically relevant arrhythmias that require further device and/or medical therapy are often missed with Holier ECGs in patients with advanced stage Fabry cardiomyopathy, but they can be detected by telemonitoring with an implantable loop recorder.
Psychosocial factors affect mental health and health-related quality of life (HRQL) in a complex manner, yet gender differences in these interactions remain poorly understood. We investigated whether psychosocial factors such as social support and personal and work-related concerns impact mental health and HRQL differentially in women and men during the first year of the COVID-19 pandemic. Between June and October 2020, the first part of a COVID-19-specific program was conducted within the “Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB)” cohort study, a representative age- and gender-stratified sample of the general population of Würzburg, Germany. Using psychometric networks, we first established the complex relations between personal social support, personal and work-related concerns, and their interactions with anxiety, depression, and HRQL. Second, we tested for gender differences by comparing expected influence, edge weight differences, and stability of the networks. The network comparison revealed a significant difference in the overall network structure. The male (N = 1370) but not the female network (N = 1520) showed a positive link between work-related concern and anxiety. In both networks, anxiety was the most central variable. These findings provide further evidence that the complex interplay of psychosocial factors with mental health and HRQL decisively depends on gender. Our results are relevant for the development of gender-specific interventions to increase resilience in times of pandemic crisis.
Functional versus morphological assessment of vascular age in patients with coronary heart disease
(2021)
Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VA(PWVao) in 68% of patients; for VA\(_{AIao}\) in 52% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VA\(_{total-cIMT}\) accelerated vascular aging in 75% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility.