Reiner Körfer

Bio: Reiner Körfer is an academic researcher from Ruhr University Bochum. The author has contributed to research in topics: Heart transplantation & Transplantation. The author has an hindex of 39, co-authored 240 publications receiving 5546 citations. Previous affiliations of Reiner Körfer include Heart and Diabetes Center North Rhine-Westphalia.

Prosthetic valve endocarditis

Abstract: After 40 years of continuous improvements in the design and materials used for prosthetic heart valves, valve replacement surgery is now performed with low morbidity and mortality. These advantages have been hampered by a few but severe adverse effects; in particular, infections of the prosthetic material continue to be an extremely serious complication occurring with a relatively low but increasing frequency ranging from 0.1–2.3% per patient year.1-3 The prosthesis obviously predisposes to device related infections, especially those caused by novobiocin susceptible, coagulase negative staphylococci, which are able to adhere to a variety of surfaces4 and produce an antibiotic resistant biofilm.5 6 Prosthetic valve endocarditis (PVE) is an endovascular, microbial infection occurring on parts of a valve prosthesis or on reconstructed native heart valves.7 It is recommended to determine whether (a) a mechanical prosthesis, (b) a bioprosthetic xenograft, stented or unstented, (c) an allograft, (d) a homograft, or (e) a repaired native valve with or without implantation of an annular ring is involved.8 Although clinical relevance and therapeutic considerations may be similar, infections of devices or lines placed inside the heart but not connected to the endocardial structures should be classified as “polymer associated infections” rather than PVE. PVE should be classified as either being acquired perioperatively, and thus nosocomial (early PVE), or as community acquired (late PVE).8 Because of significant differences in microbiology of PVE observed within the first year of operation and later on, the time cut off point between early and late PVE should be regarded as one year.9 The risk for early PVE is higher (approximately 5%) in patients with replacement surgery during active infective endocarditis, especially if the causal organism is unknown or the antibiotic treatment is insufficient. The incidence of late PVE is lower for mechanical prostheses than …

Predictors of mortality after aortic valve replacement

Abstract: Aortic valve replacement (AVR) is recommended as a standard surgical procedure for aortic valve disease. Still the evidence for commonly claimed predictors of post-AVR prognosis, in particular mortality, appears scant. This systematic review reports on the evidence for predictors of post-AVR mortality, and may be helpful in pre-surgical risk-stratification. In PubMed, we searched for original reports of post-AVR follow-up studies. We assessed the quality of study design and methods with a standardized checklist. Data of the reported predictors of mortality and outcomes were extracted. Twenty-eight studies met our inclusion criteria. Sixteen studies were considered of high quality. There is strong evidence that the risk of early mortality is increased by emergency surgery, while the risk of late mortality is increased with older age and preoperative atrial fibrillation. There is moderate evidence that the risk of early mortality is increased by older age, aortic insufficiency, coronary artery disease, longer cardiopulmonary bypass time, reduced left ventricular ejection fraction (LV-EF), infective endocarditis, hypertension, mechanical valves, preoperative pacing, dialysis-dependent renal failure and valve size; and that the risk for late mortality is increased by emergency surgery and urgency of the operation. There is little evidence for high New York Heart Association class, concomitant coronary artery bypass graft and many other commonly claimed risk factors for post-AVR mortality. The reported evidence on predictors of post-AVR mortality will help for pre-surgical risk-stratification, i.e. to discern patients at high or low risk for early and late post-AVR mortality. Future prognostic studies should take the evidence from this review into account and should focus on derivation of a predictive model for post-AVR survival.

Plasma biomarkers of myocardial fibrosis and remodeling in terminal heart failure patients supported by mechanical circulatory support devices.

Abstract: Background In this study we analyzed putative biomarkers for myocardial remodeling in plasma from 55 endstage heart failure patients with the need for mechanical circulatory support (MCS). We compared our data to 40 healthy controls and examined if MCS by either ventricular assist devices or total artificial hearts has an impact on plasma concentrations of remodeling biomarkers. Methods & Results Plasma biomarkers were analysed pre and 30 days post implantation of a MCS device using commercially available enzyme linked immunosorbent assays (ELISA). We observed that the plasma concentrations of remodeling biomarkers: tissue inhibitor of metalloproteinase 1 (TIMP1), tenascin C (TNC), galectin 3 (LGALS3), osteopontin (OPN) and of neurohumoral biomarker brain natriuretic peptide (BNP), are significantly elevated in patients with terminal heart failure compared to healthy controls. We did not find elevated plasma concentrations for matrix metalloproteinase 2 (MMP2) and procollagen I C-terminal peptide (PCIP). However, only BNP plasma levels were reduced by MCS, whereas the concentrations of remodeling biomarkers remained elevated or even increased further 30 days after MCS. LGALS3 plasma concentrations at device implantation were significantly higher in patients who did not survive MCS due to multi organ failure (MOF). Conclusions Our findings indicate that mechanical unloading in endstage heart failure is not reflected by a rapid reduction of remodeling plasma biomarkers.

Cardiac remodelling in end stage heart failure: upregulation of matrix metalloproteinase (MMP) irrespective of the underlying disease, and evidence for a direct inhibitory effect of ACE inhibitors on MMP

Abstract: Objective: To investigate matrix metalloproteinases (MMP-2 and MMP-9) in heart failure caused by ischaemic and idiopathic dilated cardiomyopathy, and the impact of angiotensin converting enzyme (ACE) inhibition on MMP. Design and main outcome measures: MMP were extracted from myocardium of patients with heart failure (coronary artery disease, n = 13; idiopathic dilated cardiomyopathy (IDCM), n = 16) and from controls (n = 6). The active form of MMP-2 and MMP-9 was measured by enzyme linked immunosorbent assay; activity of MMPs by zymography; mRNA expression of MMPs by reverse transcriptase polymerase chain reaction. Results: Active MMP-9 was significantly increased in coronary artery disease (mean (SD) 1.6 (0.35) ng/ml) and IDCM (2.11 (0.54) ng/ml) in comparison with controls (0.53 (0.15) ng/ml). Increased MMP-2 was only found in IDCM (3.68 (0.41) ng/ml). There were corresponding increases in MMP activity but no upregulation of mRNA expression was found. The ACE inhibitors captopril and ramiprilate inhibited MMP-2 and MMP-9 activity in vitro (inhibitory capacity (IC 50 ), in mmol/l: MMP-2: captopril 2.0 (0.16), ramiprilate 2.1 (0.3); MMP-9: captopril 1.65 (0.18), ramiprilate 2.0 (0.3)). Lisinopril inhibited MMP-9 significantly but did not inhibit MMP-2 in vitro (IC 50 MMP-2: 7.4 (0.88); MMP-9: 7.86 (2.23)). Inhibition of MMP activity by ACE inhibitors was blunted by zinc excess. Conclusions: Upregulation of MMP-9 activity is common in the failing myocardium, independent of the underlying disease. Missing upregulation of transcription suggests that activation of latent forms of MMP is the source of increased MMP activity, rather than increased de novo synthesis. Some ACE inhibitors may influence MMP activity by a direct effect.

Vitamin D Deficiency

Abstract: Once foods in the United States were fortified with vitamin D, rickets appeared to have been conquered, and many considered major health problems from vitamin D deficiency resolved. But vitamin D deficiency is common. This review considers the role of vitamin D in skeletal and nonskeletal health and suggests strategies for the prevention and treatment of vitamin D deficiency.

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Abstract: PREAMBLE......e4 APPENDIX 1......e121 APPENDIX 2......e122 APPENDIX 3......e124 REFERENCES......e124 It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure

Abstract: Background Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated. Methods We randomly assigned 129 patients with end-stage heart failure who were ineligible for cardiac transplantation to receive a left ventricular assist device (68 patients) or optimal medical management (61). All patients had symptoms of New York Heart Association class IV heart failure. Results Kaplan–Meier survival analysis showed a reduction of 48 percent in the risk of death from any cause in the group that received left ventricular assist devices as compared with the medical-therapy group (relative risk, 0.52; 95 percent confidence interval, 0.34 to 0.78; P=0.001). The rates of survival at one year were 52 percent in the device group and 25 percent in the medical-therapy group (P=0.002), and the rates at two years were 23 percent and 8 percent...

2015 ESC Guidelines for the management of infective endocarditis

Abstract: 3D : three-dimensional AIDS : acquired immune deficiency syndrome b.i.d. : bis in die (twice daily) BCNIE : blood culture-negative infective endocarditis CDRIE : cardiac device-related infective endocarditis CHD : congenital heart disease CIED : cardiac implantable electronic device