Heart and Diabetes Center North Rhine-Westphalia

About: Heart and Diabetes Center North Rhine-Westphalia is a healthcare organization based out in Bad Oeynhausen, Germany. It is known for research contribution in the topics: Heart failure & Vitamin D and neurology. The organization has 288 authors who have published 357 publications receiving 9276 citations.

Impact of donor lung quality on post-transplant recipient outcome in the Lung Allocation Score era in Eurotransplant – a historical prospective study

Abstract: The aim of this study was to investigate whether there is an impact of donation rates on the quality of lungs used for transplantation and whether donor lung quality affects post-transplant outcome in the current Lung Allocation Score era. All consecutive adult LTx performed in Eurotransplant (ET) between January 2012 and December 2016 were included (N = 3053). Donors used for LTx in countries with high donation rate were younger (42% vs. 33% ≤45 years, P < 0.0001), were less often smokers (35% vs. 46%, P < 0.0001), had more often clear chest X-rays (82% vs. 72%, P < 0.0001), had better donor oxygenation ratios (20% vs. 26% with PaO2/FiO2 ≤ 300 mmHg, P < 0.0001), and had better lung donor score values (LDS; 28% vs. 17% with LDS = 6, P < 0.0001) compared with donors used for LTx in countries with low donation rate. Survival rates for the groups LDS = 6 and ≥7 at 5 years were 69.7% and 60.9% (P = 0.007). Lung donor quality significantly impacts on long-term patient survival. Countries with a low donation rate are more oriented to using donor lungs with a lesser quality compared to countries with a high donation rate. Instead of further stretching donor eligibility criteria, the full potential of the donor pool should be realized.

Acute improvement of pulmonary hemodynamics does not alleviate Cheyne-Stokes respiration in chronic heart failure—a randomized, controlled, double-blind, crossover trial

Abstract: This randomized, controlled trial aimed to investigate whether acute improvement of pulmonary congestion would reduce the severity of Cheyne-Stokes respiration (CSR) in patients with chronic heart failure (CHF). Twenty-one consecutive patients with CHF and CSR (apnea-hypopnea index [AHI] ≥15/h) underwent right heart catheterization with titration of intravenous (IV) glyceryltrinitrate (GTN) to a maximum tolerable dosage and inhalation of iloprost 10 μg/mL after a washout phase. Maximum tolerable dosages of GTN and iloprost were randomly applied during full cardiorespiratory polysomnography within two split-night procedures and compared with IV or inhaled sodium chloride (NaCl) 0.9 %, respectively. GTN (6.2 ± 1.5 mg/h) and iloprost significantly lowered \mean pulmonary artery pressure (20.1 ± 9.0 to 11.6 ± 4.2 mmHg, p < 0.001 and 16.9 ± 7.9 to 14.2 ± 6.4 mmHg, p < 0.01, respectively). Pulmonary capillary wedge pressure was only reduced by GTN (14.0 ± 5.6 to 7.2 ± 3.9 mmHg, p < 0.001), and there was no significant change in the cardiac index. Sleep studies revealed no significant improvement in markers of CSR severity, including AHI, central apnea index, and CSR cycle length following GTN or iloprost treatment. Significant decreases in blood pressure, mean oxygen saturation, and S3 sleep were documented during GTN infusion. Acute improvement of pulmonary congestion by GTN had no immediate impact on CSR severity. Future investigations must therefore include longer treatment periods and treatment regimens that have positive, rather than negative, additional effects on peripheral and central chemoreceptors and sleep structure. German Clinical Trial Registry-ID:DRKS00000467 ( www.germanctr.de )

The Paclitaxel-Eluting Coroflex™ Stent Study II (PECOPS II) Acute and 6-Month Clinical and Angiographic Follow-Up, 1-Year Clinical Follow-Up

Abstract: Background and Objectives: Paclitaxel-coated stents have proven their efficacy for reducing restenosis in de novo coronary artery lesions and in-stent restenoses with superiority compared to bare metal stents. This study was performed to evaluate the procedural and 1 year results of the Paclitaxel-eluting Coroflex™ Please stent in coronary artery lesions. Methods: One-hundred and twenty-nine patients (66.2 ± 8.2 years, 31.0% diabetics, 20.2% unstable angina, 41.8% multivessel disease) were enrolled per protocol for elective single stent deployment into native de novo or post-PTCA restenotic coronary lesions.The mean reference diameter was 2.84 ± 0.43 mm, the lesion length 12.51 ± 4.6 mm, and the minimal lumen diameter 0.75 ± 0.29 mm. Follow-up was performed clinically in 129/129 (100%) after 6 and 12 months and angiographically in 120/129 (93%) patients after 6 months. Results: The success rates of the procedure and deployment were 100% and 95.3%, respectively. The in-stent late loss and the late-loss index were 0.27 ± 0.59 mm and 0.17 ± 0.40 resulting in binary in-stent restenoses in 16/120 (13.3%) subjects and in-segment restenoses in 20/120 (16.7%) subjects. Major adverse cardiac events occurred in 23/129 (17.8%) during the first 6 months of follow-up with 3/129 (2.3%) myocardial infarctions, 1/129 (0.8%) secondary to stent thrombosis. From 6 to 12 months, 2/129 (1.6%) nonlesion related PCI were performed. Conclusion: The data of the Paclitaxel-eluting Coroflex™ Please stent evaluated in PECOPS II are within the range of the other currently available Paclitaxel-eluting stent. (J Interven Cardiol 2010;23:160-166)

Reduction in ECG abnormalities and improvement of regional left ventricular function in a patient with Fabry's disease during enzyme-replacement therapy.

Abstract: A 65-year-old German woman was admitted to our hospital with signs and symptoms of an acute coronary syndrome (NSTEMI). On admission, she reported progressive cervical and chest pain, since a few hours. On physical examination, there was a non-specific cardiac murmur with punctum maximum at Erb0s point. Lung sounds were normal, and blood pressure was 115/70 mmHg. The following laboratory data were obtained: creatine kinase of 282 U/L (reference level \171 U/L), troponin I 4.5 lg/L (reference level \0.04 lg/L), lactate dehydrogenase of 250 U/L (reference level \248 U/L), creatinine of 0.82 mg/dL (reference level 0.7–1.2 mg/dL) and C-reactive protein of 0.29 mg/dL (reference level \0.5 mg/dL). The ECG demonstrated repolarization abnormalities in leads I, II, III, aVF and V4-V6 (Fig. 1a). Cardiac catheterization excluded a significant macroangiopathy. A transthoracic echocardiogram was consistent with hypertrophic cardiomyopathy of the apical type without significant LV outflow obstruction (Fig. 2a) prompting routine screening to exclude secondary origin of LVH. A decreased a-galactosidase A activity was found and triggered further molecular genetic workup. A Fabry-specific mutation C.559.A[G (M187V) in the a-galactosidase gene was identified. In addition to symptomatic medical treatment, and in cooperation with a regional center for Fabry’s disease, the patient received continuous enzymereplacement therapy with Agalsidase-b [1]. After 1 year, the clinical status of the patient was stable. Both regression of the ST segment abnormalities (Fig. 1b) on ECG, and improvement of regional LV function (Fig. 2b) by speckle tracking echocardiography was documented [2, 3]. This report illustrates the potential of a causal therapy in patients with cardiac manifestations of Fabry’s disease.

Outcome of heart transplantation in pediatric recipients: experience in 128 patients.

Abstract: The purpose of this study was to review the outcome of pediatric heart recipients with uncorrectable congenital heart disease, failed corrective procedures, or intractable acquired cardiomyopathy. Between 1988 and 2005, cardiac transplantations were performed in 128 pediatric patients (59 girls and 69 boys) at the Heart-Center North-Rhine-Westphalia. Their ages varied between 1 week and 18 years (mean, 7.6 +/- 6.2 years). Underlying diseases were dilative cardiomyopathy in 93 cases and uncorrectable congenital heart disease in 35 cases. We diagnosed and observed 130 episodes of acute rejection in 85 patients (65.3% of patients had an acute rejection during the observation period); 71 patients were treated efficiently with steroid-pulse therapy. Monoclonal antibody OKT3 was administrated in 14 patients because of steroid-resistant acute donor organ rejection. Five of those 14 patients survived. The cumulative survival was 88% after 1 year and 68% after 10 years for all patients. Orthotopic heart transplantation is the ultimate treatment option for children with end-stage heart disease and shows an acceptable perioperative mortality rate as well as good long-term results.